Polysubstance Use Defines Overdose/Substance Disorders Now

"What clinicians have historically labeled as separate conditions-alcohol use disorder, opioid use disorder, cocaine use disorder-is now better understood as different expressions of one common vulnerability."

"These NIDA experts reported nationally-representative data from 92,000+ U.S. adults, revealing that polysubstance use is the dominant pattern among individuals with substance use disorders (SUDs). Nearly three-fourths (73%) of stimulant-involved overdose deaths also included opioids."

"If we include nicotine and cannabis-as we should-the picture shifts dramatically. Tobacco dependence is strongly connected to alcohol and other drug use, and cannabis use disorder substantially increases the likelihood of other substance involvement. When these substances are accounted for, most individuals with substance use disorders are using more than one substance. If most patients no longer have one-substance disorder, the longstanding clinical instinct to identify a "primary" substance becomes untenable."

"A second finding is the timing of substance exposure. Early initiation, particularly before age 18-is strongly associated with a greater number and severity of substance use disorders later in life. In contrast, individuals delaying initiation until age 21 or later have substantially fewer disorders and dramatically lower rates of moderate-to-severe addiction. Adolescence is a period of maturation in executive control, reward processing, stress regulation"

Alcohol, opioid, and cocaine use disorders are increasingly understood as different expressions of a common vulnerability rather than separate conditions. Nationally representative data from over 92,000 U.S. adults show polysubstance use is the dominant pattern among people with substance use disorders. Nearly three-fourths of stimulant-involved overdose deaths also include opioids. Among people with opioid, stimulant, methamphetamine, or hallucinogen use disorders, most also have at least one additional substance use disorder. Including nicotine and cannabis further increases the proportion of individuals using more than one substance, making the idea of a single primary substance less tenable. Early initiation before age 18 is associated with more and more severe substance use disorders later, while delaying initiation until 21 or later is linked to fewer disorders and lower rates of moderate-to-severe addiction. Adolescence involves maturation of executive control, reward processing, and stress regulation.

Read at Psychology Today