Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA; Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN, 47405, USA.
Drug Alcohol Depend. 2020 Jul 1;212:107998. doi: 10.1016/j.drugalcdep.2020.107998. Epub 2020 Apr 25.
Polysubstance use (PSU; lifetime use of multiple substances) is common among individuals with problematic alcohol/substance use and is associated with poor prognosis and poor physical/mental health. Furthermore, simultaneous co-use of substances, such that drug effects overlap, is also common and related to unique risks (e.g. overdose). Despite the importance of PSU, current diagnostic systems continue to conceptualize problems with alcohol/substances as class-specific constructs (e.g. Stimulant Use Disorder), which essentially ignore many unique PSU processes.
The current study modeled problems with alcohol, cannabis, stimulants, sedatives, opiates, and simultaneous co-use of these substances as a manifestation of a general substance use continuum versus as correlated class-specific constructs in a sample of young-adults(n = 2482) using confirmatory factor analysis. Utility of the models was evaluated by examining associations between the general substance use spectrum and class-specific latent factors with measures of anxiety, ADHD, adult antisocial problems, borderline symptoms, neuroticism, and intelligence in a subset of the sample(n=847).
Findings supported the conceptualization of problems with all substances, including co-use of substances, as being manifestations of a general substance use spectrum, as class-specific constructs were not differentially associated with other measures of psychological dysfunction. Examination of this general substance use spectrum indicated that all substances, separately and co-use, were robustly informative of this spectrum, but tended to discriminate between different severity levels.
The general substance use spectrum allows for integration of information from the use and co-use of all substances to provide better assessment of overall problems with substances compared to class-specific constructs.
多物质使用（PSU；一生中使用多种物质）在有问题的酒精/物质使用个体中很常见，与不良预后和较差的身体/心理健康相关。此外，同时使用多种物质，即药物效应重叠，也很常见，并且与独特的风险相关（例如，过量）。尽管 PSU 很重要，但目前的诊断系统继续将酒精/物质问题概念化为特定类别的构建体（例如，兴奋剂使用障碍），这实际上忽略了许多独特的 PSU 过程。
本研究在一个青年样本（n=2482）中，使用验证性因子分析，将酒精、大麻、兴奋剂、镇静剂、阿片类药物和同时使用这些物质的问题，作为一般物质使用连续体的表现，而不是作为相关的特定类别构建体，对酒精、大麻、兴奋剂、镇静剂、阿片类药物和同时使用这些物质的问题进行建模。通过在样本的一个子集（n=847）中，检查一般物质使用范围与特定类别潜在因素与焦虑、ADHD、成年反社会问题、边缘症状、神经质和智力等测量指标之间的关联，评估模型的有效性。
研究结果支持将所有物质的问题，包括物质的同时使用，概念化为一般物质使用范围的表现，而特定类别的构建体与其他心理功能障碍测量指标没有差异关联。对一般物质使用范围的检查表明，所有物质，单独和同时使用，都能很好地反映出这一范围，但往往能区分不同的严重程度。
一般物质使用范围允许整合所有物质的使用和同时使用信息，与特定类别的构建体相比，提供更好的整体物质问题评估。
