Simultaneous Polysubstance Use Research Articles

Behavioural patterns and dangers: a mixed-methods exploration of simultaneous polysubstance use and intervention strategies among Swiss adolescents.

Recent trends in Switzerland indicate a concerning rise in simultaneous polysubstance use among adolescents, a practice marked by the concurrent or sequential consumption of multiple psychoactive substances, notably alcohol and cannabis, alongside prescription medications (e.g. benzodiazepines) and illicit drugs, resulting in dozens of fatal outcomes. However, data on simultaneous polysubstance use and evidence-based approaches to effective prevention is lacking. The study aimed to explore and gain insights into use patterns, use settings, use motives, harm-reduction strategies, concerns associated with substance use, and support and counselling services from the point of view of adolescents practicing simultaneous polysubstance use in Switzerland. An exploratory study was conducted via an online survey (n = 116) and two focus group discussions with affected Swiss adolescents aged 14 to 20. A mixed-methods approach was applied to gain insights and better understand the phenomenon of simultaneous polysubstance use among Swiss adolescents. Quantitative survey data obtained between November 2021 and March 2023 by means of convenience sampling - organised by distributing flyers (in three national languages) among several project partners, on the internet, over social media and by word of mouth - was analysed descriptively, whereas qualitative survey data and focus group data were thematically explored. A concurrent nested design was employed, utilising quantitative findings as a core foundation for addressing research questions, while qualitative findings were instrumental in validating and providing contextual depth to the results. Our findings reveal a preference of the sample for combining alcohol with cannabis and/or other substances (e.g. benzodiazepines or hard drugs) in social settings, driven by diverse motives, including enhancement of experiences and partly maladaptive coping mechanisms leading to self-medication. Despite some awareness of the potential harms, there is a significant reliance on peer-shared strategies for harm reduction, highlighting a gap in formal support and counselling services, some of which are perceived by adolescents as lacking empathy and relevance. This study underscores the urgency of developing targeted, youth-centred interventions that resonate with the lived realities of adolescents, aiming not only to reduce substance use but also to address the broader psychosocial factors contributing to simultaneous polysubstance use. By shedding light on the complex dynamics of adolescent polysubstance use, our research contributes to the ongoing dialogue on effective prevention strategies, advocating for a holistic approach encompassing education, policy reform and community support to tackle this multifaceted public health challenge.

The Association Between Adolescent Vaping and Subsequent Use of Other Substances and Risk Factors for Polysubstance Use

Abstract Objectives Adolescent vaping has become a public health concern. The aim of this study was to examine the associations between adolescent vaping and subsequent use of other substances and risk factors for polysubstance use. Methods The Well-being and Experiences Study is a longitudinal, intergenerational study conducted in Manitoba, Canada. The sample for this study consisted of adolescents and emerging adults who participated in Waves 1 (N = 1,002; 2017-18; aged 14–17 years) and 2 (n = 756; 2019; aged 15–20 years). Multinomial logistic regression analysis was performed. Results Adolescent vaping was associated with continued use of alcohol, cannabis, and cigarettes (adjusted relative risk ratio [aRRR] range: 12.92–19.39), new onset use of cannabis (aRRR: 6.04) and cigarettes (aRRR: 3.66), and concurrent and simultaneous polysubstance use (aRRR range: 3.14–24.25). Several risk factors were identified for concurrently using three or four substances in the past year (aRRR range: 1.76–2.86) and simultaneously using alcohol, cannabis, and nicotine (aRRR range: 1.99–3.11). Among those who reported vaping nicotine at Wave 2, 33.6% of males and 24.2% of females reported doing so as a coping mechanism. Conclusions Adolescent vaping is a risk factor for subsequent use of other substances and polysubstance use. Efforts are needed to prevent vaping initiation and help adolescents with cessation. Strategies should include selective interventions for those with histories of childhood adversity and mental health disorder.

Harm Reduction Strategies and Drug-Related Negative Consequences in the Dance Music Scene: The Moderating Role of Polysubstance Use

Introduction Although simultaneous polysubstance use (SPU) is associated with greater harms than concurrent polysubstance use (CPU), no previous research has examined the effectiveness of harm reduction strategies in reducing drug-related harms in people who use drugs simultaneously and whether these strategies have a differential impact on drug-related negative consequences according to SPU patterns. Objectives: to examine the relationship between SPU patterns, harm reduction strategies and drug-related consequences experienced among people who attend dance music settings, and to examine the moderating role of SPU patterns in the relationship between harm reduction strategies and drug-related negative consequences Methods: a web-based survey was used to gather data from 649 substance-using attendees at dance music settings (mean age = 26.2, 68% male). The survey collected data on: settings of last party attended, drug use, harm reduction strategies used and drug-related negative consequences experienced during last party attended. Results: Latent class analysis identified two SPU profiles: Moderate SPU and Severe SPU. Participants in the severe SPU class experienced more drug-related negative consequences at their last party in comparison with those in the moderate SPU class. Regardless of SPU pattern, avoiding binge drinking was related to fewer drug-related negative consequences, whilst avoiding mixing stimulants was related to fewer drug-related negative consequences only among those participants in the severe simultaneous polysubstance use class. Conclusions: These findings could help to inform the design of messages and tailored interventions aimed at minimizing drug-related negative consequences among people who use multiple substances in the dance music scene.

Patterns of Simultaneous Polysubstance Use among Partygoers: Correlates and Differences in Adverse Acute Effects Experienced

ABSTRACT This study identifies patterns of simultaneous polysubstance use (SPU) in partygoers, their associated characteristics, and their differences in terms of acute effects experienced. We used a web-based survey with 1345 partygoers who reported using at least one substance during the past year, collecting information on drug use and drug-related acute effects experienced at the last party attended. Latent class analysis identified three SPU profiles according to the use of nine substances: low polysubstance use (67.7%), moderate polysubstance use/hallucinogens (11.6%), and extensive polysubstance use/stimulants (20.7%). These profiles differed in their sociodemographic characteristics and were associated with different odds of experiencing adverse drug-related effects. Compared with participants with a profile of low polysubstance use or moderate polysubstance use/hallucinogens, those in the extensive polysubstance use/stimulants group were at higher odds of experiencing memory impairment, tachycardia, and bad mood after drug use. The only differences between the low polysubstance use and moderate polysubstance use/hallucinogens groups were in terms of hangover and headache experiences, which were less likely in the latter group (who consume less alcohol). Knowledge regarding the acute adverse drug-related effects experienced by partygoers who use multiple drugs can help to develop interventions for reducing drug-related risks in this population.

Identifying subtypes of cannabis users based on simultaneous polysubstance use

BackgroundCannabis use patterns vary considerably, with many users reporting simultaneous and non-simultaneous use (co-use) of other substances. Despite this, little research has examined the extent to which subtypes of cannabis users may be identified based on their simultaneous and co-use behaviors. MethodsThe sample consisted of adult Australian twins and siblings who reported lifetime cannabis use (n = 2590). A latent class analysis was conducted to determine subtypes of cannabis users based on five indicators of substance co-use and simultaneous use. Adolescent correlates (age of substance initiation and conduct disorder) and adult correlates (substance use/disorder and depression) of class membership were assessed. Twin similarity for class membership was also examined. ResultsFour subtypes of users were identified: 1) alcohol co-users, 2) simultaneous alcohol users, 3) simultaneous tobacco users, and 4) simultaneous alcohol, tobacco, and drug users. Compared to co-users of alcohol, simultaneous alcohol users were at increased risk for alcohol problems. Patterns of use that involved simultaneous tobacco and cannabis use (i.e., simultaneous tobacco users and simultaneous alcohol, tobacco, and drug users) were associated with the most problematic outcomes, including substance use and disorder. There was evidence for genetic influences (12–58%) on cannabis use patterns, with higher concordance for latent class membership among monozygotic compared to dizygotic twins (χ2 (1) = 7.19, p = 0.007). ConclusionsThe current study identified four classes of cannabis users at varying degrees of risk. Results suggest that simultaneous tobacco and cannabis use may be especially associated with deleterious outcomes.

Gender Differences in the Association Between Religion/Spirituality and Simultaneous Polysubstance Use (SPU).

While religion/spirituality strongly protects against drug use (Cheney et al. in J Drug Issues 44(1):94-113, 2014), little is known about gender differences in the association of religion/spirituality on simultaneous polysubstance use (SPU) among those who use prescription opioids. Data come from a community-based study that recruited community members from the St Louis area (N=632). Participants were asked whether they used prescription opioids when not prescribed for them or in ways other than prescribed in the past 12months. Religion/spirituality was categorized as high, medium, or low based on personal views on the importance of religion and spirituality, attendance at religious services, and advice seeking from religious leaders. SPU was defined as non-medical use of opioids simultaneously with use of cocaine, alcohol, ecstasy, or marijuana. Multivariate logistic regression determined the association between religion/spirituality, demographic variables, and SPU. Men with high levels of religion/spirituality had 63% decreased odds of SPU compared with men with low levels. Other variables associated with SPU in men were four or more arrests (AOR 2.21), multiple sex partners (AOR 2.11), and opioid use without a prescription (AOR 3.04). Women with high or medium levels of religion/spirituality had 58 and 62% decreased odds of SPU compared with women with low levels. Variables that predicted SPU in women also included 4+ arrests (AOR 5.00) and never being married (AOR 2.13). Being African-American was associated with decreased odds of SPU in women (AOR 0.32). Overall, a high level of religion/spirituality was associated with lower odds of SPU. Gender differences in this association were evident, whereas women with even a medium level of religion/spirituality had significantly decreased odds of SPU. Future drug prevention and interventions should consider the relevance of religion/spirituality in SPU.

Simultaneous polysubstance use among Danish 3,4‐methylenedioxymethamphetamine and hallucinogen users: combination patterns and proposed biological bases

To describe patterns of simultaneous polysubstance use (SPU) among Danish 3,4-methylenedioxymethamphetamine (MDMA) ("Ecstasy") and hallucinogen users. A cross-sectional survey of 98 active MDMA and/or hallucinogen users recruited through homepage advertisements, flyers, and word of mouth in Denmark. Lifetime and recent substance use and SPU at last recalled use was described by structured interviews. Hair samples from a subset of participants were analyzed for MDMA. The participants had used an average of 12.6 (95% confidence interval: 11.7-13.4) psychoactive substances during their lifetime. SPU was prevalent among MDMA, d-lysergic acid diethylamide (LSD), and psilocybin users, in particular with alcohol and cannabis. Among MDMA users, 69% had combined MDMA with amphetamines, 56% with hallucinogens, and 47% with cocaine. At last recalled use, MDMA was taken with 2.1 ± 1.2 substances in 32 different combinations. The participants preferred specific drug combinations and named several, which in their experience enhanced or counteracted each other. Alcohol and cannabis were typically used before, during, and after MDMA, LSD, and psilocybin, whereas amphetamines were predominantly taken before these substances. When LSD was combined with MDMA, the majority took MDMA after LSD. Simultaneous polysubstance use was common among Danish MDMA and hallucinogen users, and patterns of preferred substance combinations were evident.

Substance use initiation: The role of simultaneous polysubstance use

Simultaneous polysubstance use (SPU) is a common phenomenon, yet little is known about its role in substance use initiation. In the present study, 226 cannabis users completed structured interviews about their substance use history. For each substance ever used, participants provided details of their age of first use, their use in the preceding 30 days and whether they co-administered any other licit or illicit substances the first time they used the substance. For most illicit substances [powder cocaine, crack, amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA; ecstasy), heroin, opium, gamma-hydroxybutyric acid (GHB), ketamine, psilocybin (magic mushrooms), mescaline, phencyclidine (PCP), peyote and inhalants], results showed that a clear majority of participants (≥75%) reported SPU during their first-ever use of the substance. While SPU was less common on occasions of first use of alcohol, tobacco and cannabis, a high proportion of SPU on occasions of first use of 'harder' drugs could be accounted for by the co-use of alcohol, tobacco and/or cannabis. Such findings raise the possibility that specific alcohol, tobacco and/or cannabis use episodes might directly contribute to the initiation of new substance use. Understanding the role of SPU on occasions of first use might help better identify risk factors for substance use progression and improve intervention efforts.

Functions and harms associated with simultaneous polysubstance use involving alcohol and cocaine

Objectives: Alcohol is among the most common psychoactive substances to be co-administered with a variety of other drugs. It is frequently used simultaneously (i.e. on the same occasion) with cocaine. The objectives of this qualitative investigation are (1) to explore the functions and motivational factors underlying the simultaneous use of alcohol and cocaine, and (2) to explore the associated consequences.Methods: In-depth open-ended interviews with simultaneous alcohol and cocaine users were conducted at a residential treatment centre in Ontario, Canada (n = 10). The interview transcripts were coded by two independent coders. A thorough content analysis of the transcripts was performed in order to identify themes.Findings: Respondents used cocaine and alcohol simultaneously to control cravings; to alter their state of consciousness; to manage their emotions; to enhance sexual, physical and social functioning; and to minimise financial costs. Negative consequences experienced from simultaneous use include psychological, physical, social and financial harms. These findings have been used to develop potential hypotheses for testing in future studies.

The mediation role of licit drugs in the influence of socializing on cannabis use among adolescents: A quantitative approach

Licit substance use could be an early stage leading on to cannabis use. The aim of the study was to test a hypothetical sequential process leading from socializing to cannabis use so as to evaluate the mediator role of tobacco and alcohol. Data was derived from a French nationwide survey carried out in 2005 involving 29,393 teenagers aged 17. The analysis used structural equation modelling. The sequence tested was: socializing with friends– tobacco/ alcohol use– cannabis use– cannabis use disorders (CUD). Tobacco and alcohol consumptions appeared to be similarly influenced by the time spent with friends. However, tobacco mediation explained 57% of the sequence leading to cannabis use and 61% of the sequence leading to CUD, while the role of alcohol was weaker, at around 13%. Our results underline the effect of peer influence, in the course of night-out socializing, on substance use among adolescents, and the importance of tobacco mediation in the process leading to cannabis use and misuse. This suggests that prevention in places frequented by adolescents should primarily target tobacco consumption, which explains the largest part of cannabis use variance. However, processes linking substance uses seem to be more complex, with the existence of reverse pathways from cannabis to licit drugs. Thus, the gateway effects of tobacco and alcohol require further exploration in relation to simultaneous polysubstance use.

Under double influence: Assessment of simultaneous alcohol and cannabis use in general youth populations

Background/aims We assessed to what extent adolescents use alcohol and cannabis simultaneously and expanded previous research by estimating the proportion of all events of cannabis use that had occurred in relation to drinking. How the prevalence of this form of polysubstance use co-varied with the overall level of alcohol and cannabis use in different countries was also examined. Method : We analysed individual level data from a survey of 14–20 year-olds in Norway ( n = 16 813) and population level data from the 2003 ESPAD study on substance use among 15–16 year-olds in 35 European countries. Results : The prevalence of simultaneous intake of alcohol and cannabis in the past year among Norwegian youth was 7%. The overall prevalence of cannabis use was only slightly higher (8%), implying that a majority (82%) of the cannabis users had taken the drug in combination with alcohol. Moreover, in about 80% of all incidents of cannabis use, alcohol had been consumed as well. Correspondingly, a majority of the cannabis users in most of the countries in the ESPAD study had used the drug in combination with alcohol. Such simultaneous polysubstance use was more prevalent in countries where cannabis use was relatively widespread and alcohol rather frequently consumed. Conclusion Because adolescents most often combine cannabis with alcohol, their use of the drug may be more harmful than assumed. The results also indicate that cannabis is a complement rather than a substitute for alcohol, suggesting that policies that reduce adolescent drinking may reduce the use of cannabis as well.

Patterns of simultaneous polysubstance use in drug using university students

Simultaneous polysubstance use (SPU) is a common phenomenon, yet little is known about how various substances are used with one another. In the present study 149 drug-using university students completed structured interviews about their use of various substances. For each substance ever used, participants provided details about the type, order and amount of all substances co-administered during its most recent administration. Alcohol, tobacco and cannabis were frequently co-administered with each other and with all other substances. Chi-squared tests revealed that when alcohol was used in combination with any of cannabis, psilocybin, MDMA, cocaine, amphetamine, methylphenidate (ps < 0.01) or LSD (p < 0.05) its initial use preceded the administration of the other substance. Paired samples t-tests revealed that when alcohol was used with cocaine (p < 0.01) or methylphenidate (p < 0.05) it was ingested in greater quantities than when used in their absence. Patterns of cannabis use were not systematically related to other substances administered. Finally, using one-sample t-tests, tobacco use was demonstrated to be increased relative to 'sober' smoking rates when used with alcohol, cannabis, psilocybin, MDMA, cocaine, amphetamine (ps < 0.001), LSD (p < 0.01) or methylphenidate (p < 0.05). Results suggest that many substances are routinely used in a SPU context and that the pattern in which a substance is used may be related to other substances co-administered.

Contemporaneous relationship between substance abuse treatment and poly-substance use: Evidence from the Persistent Effect of Treatment Studies

Data from the Persistent Effect of Treatment Studies (PETS) are used to explore the relationship between duration of substance use treatment and simultaneous poly-substance using behaviors. Studying such contemporaneous relationships is especially important given the chronic nature of the substance-using population (McLellan, 2002) in the PETS study. Data were collected at intake to treatment programs and follow-up interviews were performed periodically at treatment program sites. One of the features of the analysis was the development of a poly-substance scale to measure multiple substance use. Multilevel models were implemented to examine the relationship between three levels of care (i.e., intensive outpatient, outpatient, and residential) and simultaneous poly-substance use. Contemporaneous effects of treatment were obtained such that higher duration of treatment was associated with drops in substance-using behaviors. This result supports the need for sustaining treatment for a population of chronic substance abusers.

Patterns of Simultaneous Polysubstance Use in Canadian Rave Attendees

The aim of this study was to examine rave-related polydrug drug use and to determine if patterns of substance use were associated with previous rave attendance. One hundred and eighty-six rave attendees (50% female) representing a wide range of ages (16 to 47 years; mean = 23.5, sd = 5.15) and levels of rave attendance experience (1 to 400 events) completed structured interviews in Montreal, Canada between November 2002 and September 2003 about their rave attendance patterns and their use of various licit and illicit substances at the most recently attended event. On average, participants reported using 2.5 different psychoactive substances (excluding tobacco) at the most recent event attended. Cannabis, alcohol, MDMA (ecstasy), amphetamine, cocaine, ketamine, and GHB were the most frequently reported substances, and details about their orders of administration, dosages, and patterns of co-administration are presented and discussed. The total lifetime number of raves attended by participants varied considerably (mean = 48.6; sd = 69.7; median = 25), and there was a positive correlation between the number events attended and number of substances used at the most recent event attended (p < 0.001). Analyses revealed that individuals reporting the use of ketamine, GHB, and/or cocaine at the most recent event had attended significantly more events than nonusers even when controlling for various demographic variables. A subset of respondents (n = 27) completed a second interview to determine the reliability of their responses. Results indicated that respondents could reliably recall details about which drugs were used, the total doses administered, as well as order of drug administration.