Abstract
Background: Simultaneous polydrug use (SPU) may represent a greater incremental risk factor for human health than concurrent polydrug use (CPU). However, few studies have examined these patterns of use in relation to health issues, particularly with regard to the number of drugs used.
Methods: In the present study, we have analyzed data from a representative sample of 5734 young Swiss males from the Cohort Study on Substance Use Risk Factors. Exposure to drugs (i.e., alcohol, tobacco, cannabis, and 15 other illicit drugs), as well as mental, social and physical factors, were studied through regression analysis.
Results: We found that individuals engaging in CPU and SPU followed the known stages of drug use, involving initial experiences with licit drugs (e.g., alcohol and tobacco), followed by use of cannabis and then other illicit drugs. In this regard, two classes of illicit drugs were identified, including first uppers, hallucinogens and sniffed drugs; and then “harder” drugs (ketamine, heroin, and crystal meth), which were only consumed by polydrug users who were already taking numerous drugs. Moreover, we observed an association between the number of drugs used simultaneously and social issues (i.e., social consequences and aggressiveness). In fact, the more often the participants simultaneously used substances, the more likely they were to experience social problems. In contrast, we did not find any relationship between SPU and depression, anxiety, health consequences, or health.
Conclusions: We identified some associations with SPU that were independent of CPU. Moreover, we found that the number of concurrently used drugs can be a strong factor associated with mental and physical health, although their simultaneous use may not significantly contribute to this association. Finally, the negative effects related to the use of one substance might be counteracted by the use of an additional substance.
References
1. Barrett SP, Darredeau C, Pihl RO. Patterns of simultaneous polysubstance use in drug using university students. Hum Psychopharmacol 2006;21:255–63.10.1002/hup.766Search in Google Scholar
2. Somers JM, Goldner EM, Waraich P, Hsu L. Prevalence studies of substance – related disorders: a systematic review of the literature. Can J Psychiatry 2004;49:373–84.10.1177/070674370404900606Search in Google Scholar
3. Brache K, Stockwell T, Macdonald S. Functions and harms associated with simultaneous polysubstance use involving alcohol and cocaine. J Subst Use 2012;17:399–416.10.3109/14659891.2011.583313Search in Google Scholar
4. Ball JC, Ross A. The effectiveness of methadone maintenance treatment: patients, programs, services, and outcome. Softcover reprint of the original, 1st ed. (1991). London: Springer, 2011.Search in Google Scholar
5. Darke S, Hall W. Levels and correlates of polydrug use among heroin users and regular amphetamine users. Drug Alcohol Depend 1995;39:231–5.10.1016/0376-8716(95)01171-9Search in Google Scholar
6. Hammersley R, Forsyth A, Lavelle T. The criminality of new drug users in Glasgow. Br J Addict 1990;85:1583–94.10.1111/j.1360-0443.1990.tb01646.xSearch in Google Scholar
7. Hubbard RL, Gail S, Flynn PM, Anderson J, Etheridge RM. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addict Behav 1997;11:261–78.10.1037/0893-164X.11.4.261Search in Google Scholar
8. Collins RL, Ellickson PL, Bell RM. Simultaneous polydrug use among teens: prevalence and predictors. J Subst Abuse 1998;10:233–53.10.1016/S0899-3289(99)00007-3Search in Google Scholar
9. Beswick T, Best D, Rees S, Coomber R, Gossop M, Strang J. Multiple drug use: patterns and practices of heroin and crack use in a population of opiate addicts in treatment. Drug Alcohol Rev 2001;20:201–4.10.1080/09595230123134Search in Google Scholar
10. Booth BM, Leukefeld C, Falck R, Wang J, Carlson R. Correlates of rural methamphetamine and cocaine users: results from a multistate community study. J Stud Alcohol 2006;67:493–501.10.15288/jsa.2006.67.493Search in Google Scholar PubMed
11. Malcolm BP, Hesselbrock MN, Segal B. Multiple substance dependence and course of alcoholism among Alaska native men and women. Subst Use Misuse 2006;41:729–41.10.1080/10826080500391803Search in Google Scholar PubMed
12. Patterson TL, Semple SJ, Zians JK, Strathdee SA. Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use. J Urban Health 2005;82:120–6.10.1093/jurban/jti031Search in Google Scholar
13. John D, Kwiatkowski CF, Booth RE. Differences among out-of-treatment drug injectors who use stimulants only, opiates only or both: implications for treatment entry. Drug Alcohol Depend 2001;64:165–72.10.1016/S0376-8716(01)00120-XSearch in Google Scholar
14. Petry NM. The effects of housing costs on polydrug abuse patterns: a comparison of heroin, cocaine, and alcohol abusers. Exp Clin Psychopharmacol 2001;9:47–58.10.1037/1064-1297.9.1.47Search in Google Scholar
15. Hakansson A, Schlyter F, Berglund M. Associations between polysubstance use and psychiatric problems in a criminal justice population in Sweden. Drug Alcohol Depend 2011;118:5–11.10.1016/j.drugalcdep.2011.02.014Search in Google Scholar
16. Darke S, Ross J. Polydrug dependence and psychiatric comorbidity among heroin injectors Drug Alcohol Depend 1997;48:135–41.10.1016/S0376-8716(97)00117-8Search in Google Scholar
17. Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol 2000;151:781–9.10.1093/oxfordjournals.aje.a010278Search in Google Scholar PubMed
18. Brådvik L, Berglund M, Frank A, Lindgren A, Löwenhielm P. Number of addictive substances used related to increased risk of unnatural death: a combined medico-legal and case-record study. BMC Psychiatry 2009;9:1–7.10.1186/1471-244X-9-48Search in Google Scholar PubMed PubMed Central
19. Earleywine M, Newcomb MD. Concurrent versus simultaneous polydrug use: prevalence, correlates, discriminant validity, and prospective effects on health outcomes. Exp Clin Psychopharmacol 1997;5:353–64.10.1037/1064-1297.5.4.353Search in Google Scholar
20. Martin CS. Timing of alcohol and other drug use. Alcohol Res Health 2008;31:96–9.Search in Google Scholar
21. McCabe SE, Cranford JA, Morales M, Young A. Simultaneous and concurrent polydrug use of alcohol and prescription drugs: prevalence, correlates, and consequences. J Stud Alcohol 2006;67:529–37.10.15288/jsa.2006.67.529Search in Google Scholar PubMed PubMed Central
22. Barrett SP, Gross SR, Garand I, Pihl RO. Patterns of simultaneous polysubstance use in Canadian rave attendees. Subst Use Misuse 2005;40:1525–37.10.1081/JA-200066866Search in Google Scholar PubMed
23. Olthuis JV, Darredeau C, Barrett SP. Substance use initiation: the role of simultaneous polysubstance use. Drug Alcohol Rev 2013;32:67–71.10.1111/j.1465-3362.2012.00470.xSearch in Google Scholar
24. Pape H, Rossow I, Storvoll EE. Under double influence: assessment of simultaneous alcohol and cannabis use in general youth populations. Drug Alcohol Depend 2009;101:69–73.10.1016/j.drugalcdep.2008.11.002Search in Google Scholar
25. Midanik LT, Tam TW, Weisner C. Concurrent and simultaneous drug and alcohol use: results of the 2000 National Alcohol Survey. Drug Alcohol Depend 2007;90:72–80.10.1016/j.drugalcdep.2007.02.024Search in Google Scholar
26. Decorte T. The taming of cocaine: cocaine use in European and American cities. VUB University Press, 2000.Search in Google Scholar
27. Brière FN, Fallu JS, Descheneaux A, Janosz M. Predictors and consequences of simultaneous alcohol and cannabis use in adolescents. Addict Behav 2011;36:785–8.10.1016/j.addbeh.2011.02.012Search in Google Scholar
28. Studer J, Baggio S, Mohler-Kuo M, Dermota P, Gaume J, et al. Examining non-response bias in substance use research- are late respondents proxies for non-respondents? Drug Alcohol Depend 2013;132:316–23.10.1016/j.drugalcdep.2013.02.029Search in Google Scholar
29. Aluja A, Rossier J, García LF, Angleitner A, Kuhlman M, et al. A cross-cultural shortened form of the ZKPQ (ZKPQ-50-cc) adapted to English, French, German, and Spanish languages. Pers Indiv Differ 2006;41:619–28.10.1016/j.paid.2006.03.001Search in Google Scholar
30. Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W. The sensitivity and specificity of the major depression inventory, using the present state examination as the index of diagnostic validity. J Affect Disord 2001;66:159–64.10.1016/S0165-0327(00)00309-8Search in Google Scholar
31. Olsen LR, Jensen DV, Noerholm V, Martiny K, Bech P. The internal and external validity of the major depression inventory in measuring severity of depressive states. Psychol Med 2003;33:351–6.10.1017/S0033291702006724Search in Google Scholar
32. Ware J Jr., Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220–33.10.1097/00005650-199603000-00003Search in Google Scholar PubMed
33. Hibell B, Guttermsson U, Ahlström S, Balakireva O, Bjanason T, et al. The 2011 ESPAD report – substance use among students in 36 European countries. Stockholm: ESPAD, 2012.Search in Google Scholar
34. Bucholz KK, Cadoret R, Cloninger CR, Dinwiddie SH, Hesselbrock VM, et al. A new, semi-structured psychiatric interview for use in genetic linkage studies: a report on the reliability of the SSAGA. J Stud Alcohol 1994;55:149–58.10.15288/jsa.1994.55.149Search in Google Scholar PubMed
35. Hesselbrock M, Easton C, Bucholz KK, Schuckit M, Hesselbrock V. A validity study of the SSAGA – a comparison with the SCAN. Addiction 1999;94:1361–70.10.1046/j.1360-0443.1999.94913618.xSearch in Google Scholar PubMed
36. Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health and behavioral consequences of binge drinking in college. A national survey of students at 140 campuses. J Am Med Assoc 1994;272:1672–7.10.1001/jama.1994.03520210056032Search in Google Scholar
37. Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat 1979;6:65–70.Search in Google Scholar
38. Kim RS. Standardized regression coefficients as indices of effect sizes in meta-analysis. Florida: Florida State University, 2011.Search in Google Scholar
39. Kandel D. Stages in adolescent involvement in drug use. Science 1975;190:912–4.10.1126/science.1188374Search in Google Scholar PubMed
40. Kandel DB. Examining the gateway hypothesis stages and pathways of drug involvement. Stages and pathways of drug involvement: examining the gateway hypothesis. New York: Cambridge University Press, 2002.10.1017/CBO9780511499777Search in Google Scholar
41. Kandel DB, Yamaguchi K, Klein LC. Testing the gateway hypothesis. Addiction 2006;101:470–2; discussion 4–6.10.1111/j.1360-0443.2006.01426.xSearch in Google Scholar PubMed
42. Scholey AB, Parrott AB, Buchanan T, Heffernan TM, Ling J, et al. Increased intensity of ecstasy and polydrug usage in the more experienced recreational Ecstasy/MDMA users: a WWW study. Addict Behav 2004;29:743–52.10.1016/j.addbeh.2004.02.022Search in Google Scholar PubMed
43. Merchand J, MacDonald R. Youth and rave culture: ecstasy and health. Youth Policy 1994;45:16–37.Search in Google Scholar
44. Uys JDK, Niesink RJM. Pharmacological aspects of the combined use of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) and gamma-hydroxybutyric acid (GHB): a review of the literature. Drug Alcohol Rev 2005;24:359–68.10.1080/09595230500295725Search in Google Scholar PubMed
45. Pennings EJM, Leccese AP, Wolff FAd. Effects of concurrent use of alcohol and cocaine. Addiction 2002;97:773–83.10.1046/j.1360-0443.2002.00158.xSearch in Google Scholar PubMed
46. Leri F, Bruneau J, Stewart J. Understanding polydrug use: review of heroin and cocaine co-use. Addiction 2003;98:7–22.10.1046/j.1360-0443.2003.00236.xSearch in Google Scholar PubMed
47. Boyd CJ, McCabe SE. Coming to terms with the nonmedical use of prescription medications. Subst Abuse Treat Prev Policy 2008;3:1–3.Search in Google Scholar
48. Zullig KJ, Divin AL. The association between non-medical prescription drug use, depressive symptoms, and suicidality among college students. Addict Behav 2012;37:890–9.10.1016/j.addbeh.2012.02.008Search in Google Scholar PubMed
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