Polysubstance Use Disorders in Individuals with Cannabis Use Disorder: Results from a Nationally Representative Sample (National Epidemiologic Survey on Alcohol and Related Conditions)
Restricted accessResearch articleFirst published online April, 2026
Polysubstance Use Disorders in Individuals with Cannabis Use Disorder: Results from a Nationally Representative Sample (National Epidemiologic Survey on Alcohol and Related Conditions)
Cannabis use disorder (CUD) is one of the most common substance use disorders (SUDs) worldwide and is frequently associated with high rates of polysubstance use; however, despite rising rates of polysubstance use disorders (PUD), the characteristics of individuals with both CUD and PUD remain unclear. This study, therefore, aims to examine social and clinical characteristics of adults diagnosed with CUD and comorbid PUD. It also aims to assess whether psychiatric disorders are linked to higher odds of PUD among individuals with CUD.
Methods:
Using a nationally representative U.S. dataset, we assessed 972 individuals with past-year DSM-5 CUD, grouped as CUD only, CUD individuals with one additional SUD (CUD + 1), and CUD individuals with two or more SUDs (CUD + 2). Descriptive statistics summarized social and clinical presentations; multivariate logistic regression examined factors contributing to PUD, controlling for clinical diagnoses and childhood maltreatment.
Results:
Among CUD individuals, 89.3% (n = 868) used at least one other substance in the past year, with 34.2% (n = 332) using two or more. Both the CUD + 1 and CUD + 2 groups experienced significantly more severe childhood maltreatment than CUD only. After adjusting for controls, personality disorders were associated with membership in the CUD + 1 group (odds ratio [OR]: 1.88, p = 0.01); mood disorders were associated with a higher likelihood of being in the CUD + 1 group (OR: 1.50, p = 0.049) and CUD + 2 group (OR: 2.58, p = 0.005).
Conclusion:
Mood and personality disorders were highly prevalent and linked with PUD in CUD cases. We recommend screening for these disorders in complex CUD cases.
CrummyEA, O’NealTJ, BaskinBM, et al.One is not enough: Understanding and modeling polysubstance use. Front Neurosci, 2020; 14:569; doi: 10.3389/fnins.2020.00569
2.
ZuckermannAME, WilliamsG, BattistaK, et al.Trends of poly-substance use among Canadian youth. Addict Behav Rep, 2019; 10:100189; doi: 10.1016/j.abrep.2019.100189
3.
GrantBF, SahaTD, RuanWJIII, et al.Epidemiology of DSM-5 drug use disorder: Results from the national epidemiologic survey on alcohol and related conditions–. JAMA Psychiatry, 2016; 73(1):39–47; doi: 10.1001/jamapsychiatry.2015.2132
4.
HakanssonA, SchlyterF, BerglundM. Associations between polysubstance use and psychiatric problems in a criminal justice population in Sweden. Drug Alcohol Depend, 2011; 118(1):5–11; doi: 10.1016/j.drugalcdep.2011.02.014
5.
MartinottiG, CarliV, TedeschiD, et al.Mono- and polysubstance dependent subjects differ on social factors, childhood trauma, personality, suicidal behaviour, and comorbid Axis I diagnoses. Addict Behav, 2009; 34(9):790–793; doi: 10.1016/j.addbeh.2009.04.012
6.
SteeleJL, PeraltaRL. Are Polydrug users more physically and verbally aggressive? An assessment of aggression among Mono- Versus Polydrug users in a university sample. J Interpers Violence, 2020; 35(21–22):4444–4467; doi: 10.1177/0886260517715024
7.
GjersingL, Bretteville-JensenAL. Patterns of substance use and mortality risk in a cohort of “hard-to-reach” polysubstance users. Addiction, 2018; 113(4):729–739; doi: 10.1111/add.14053
8.
WangL, MinJE, KrebsE, et al.Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users. Int J Drug Policy, 2017; 49:32–40; doi: 10.1016/j.drugpo.2017.07.009
9.
HasinDS, KerridgeBT, SahaTDIII, et al.Prevalence and correlates of DSM-5 cannabis use disorder, 2012–2013: Findings from the national epidemiologic survey on alcohol and related conditions –. Am J Psychiatry, 2016; 173(6):588–599; doi: 10.1176/appi.ajp.2015.15070907
10.
HayleyAC, StoughC, DowneyLA. DSM-5 cannabis use disorder, substance use and DSM-5 specific substance-use disorders: Evaluating comorbidity in a population-based sample. Eur Neuropsychopharmacol, 2017; 27(8):732–743; doi: 10.1016/j.euroneuro.2017.06.004
11.
AfifiTO, HenriksenCA, AsmundsonGJG, et al.Childhood maltreatment and substance use disorders among men and women in a nationally representative sample. Can J Psychiatry, 2012; 57(11):677–686; doi: 10.1177/070674371205701105
12.
KeyesKM, EatonNR, KruegerRF, et al.Childhood maltreatment and the structure of common psychiatric disorders. Br J Psychiatry, 2012; 200(2):107–115; doi: 10.1192/bjp.bp.111.093062
13.
DubeSR, FelittiVJ, DongM, et al.Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 2003; 111(3):564–572; doi: 10.1542/peds.111.3.564
14.
MerrinGJ, ThompsonK, LeadbeaterBJ. Transitions in the use of multiple substances from adolescence to young adulthood. Drug Alcohol Depend, 2018; 189:147–153; doi: 10.1016/j.drugalcdep.2018.05.015
15.
RakovskiC, LalliM, GuJ, et al.Childhood maltreatment as a predictor of substance use/misuse among youth: A systematic review and meta-analysis. Neurosci Biobehav Rev, 2024; 166:105873; doi: 10.1016/j.neubiorev.2024.105873
16.
Alvarez-AlonsoMJ, Jurado-BarbaR, Martinez-MartinN, et al.Association between maltreatment and polydrug use among adolescents. Child Abuse Negl, 2016; 51:379–389; doi: 10.1016/j.chiabu.2015.07.014
17.
HassanAN, Le FollB. Polydrug use disorders in individuals with opioid use disorder. Drug Alcohol Depend, 2019; 198:28–33; doi: 10.1016/j.drugalcdep.2019.01.031
18.
CicchettiD, HandleyED. Child maltreatment and the development of substance use and disorder. Neurobiol Stress, 2019; 10:100144; doi: 10.1016/j.ynstr.2018.100144
19.
GrantBF, ChuA, SigmanR, et al.National Institute on Alcohol Abuse and Alcoholism National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) Source and Accuracy Statement. National Institute on Alcohol Abuse and Alcoholism: Rockville, MD; 2014.
20.
Anonymous. Bureau of the Census: American Community Survey, 2012. U.S. Census Bureau: Suitland, Maryland; 2013.
21.
GrantBF, GoldsteinRB, SmithSM, et al.The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): Reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend, 2015; 148:27–33; doi: 10.1016/j.drugalcdep.2014.11.026
22.
ConnorJP, GulloMJ, WhiteA, et al.Polysubstance use: Diagnostic challenges, patterns of use and health. Curr Opin Psychiatry, 2014; 27(4):269–275; doi: 10.1097/YCO.0000000000000069
23.
SahaTD, StinsonFS, GrantBF. The role of alcohol consumption in future classifications of alcohol use disorders. Drug Alcohol Depend, 2007; 89(1):82–92; doi: 10.1016/j.drugalcdep.2006.12.003
24.
ChenCM, SlaterME, CastleI-JP, et al.Alcohol use and alcohol use disorders in the United States: Main Findings from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III).U.S. Alcohol Epidemiologic Data Reference Manual, Volume 10. National Institute on Alcohol Abuse and Alcoholism (NIAAA): Bethesda, MD; 2016.
25.
Anonymous. National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) Data Notes. National Institute on Alcohol Abuse and Alcoholism (NIAAA); n.d.
26.
StrausMA. Measuring Intrafamily conflict and violence: The Conflict Tactics (CT) scales. Journal of Marriage and Family, 1979; 41(1):75–88; doi: 10.2307/351733
27.
BernsteinDP, FinkL, HandelsmanL, et al.Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry, 1994; 151(8):1132–1136; doi: 10.1176/ajp.151.8.1132
28.
RuanWJ, GoldsteinRB, ChouSP, et al.The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend, 2008; 92(1–3):27–36; doi: 10.1016/j.drugalcdep.2007.06.001
29.
Anonymous. IBM SPSS Statistics 29.0. 2023.
30.
HalladayJ, WoockR, El-KhechenH, et al.Patterns of substance use among adolescents: A systematic review. Drug Alcohol Depend, 2020; 216:108222; doi: 10.1016/j.drugalcdep.2020.108222
31.
SilveiraML, GreenVR, IannacconeR, et al.Patterns and correlates of poly-substance use among U.S. youth ages 15–17 years: Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Addiction, 2019; 114(5):907–916; doi: 10.1111/add.14547
32.
de JongeMC, BukmanAJ, van LeeuwenL, et al.Latent classes of substance use in young adults—A systematic review. Subst Use Misuse, 2022; 57(5):769–785; doi: 10.1080/10826084.2022.2040029
33.
OuT-S, HuberL, MacyJT, et al.Trajectories of polysubstance use: Are past-year internalizing and externalizing problems associated with trajectories of polysubstance use over time? Addict Behav, 2024; 159:108136; doi: 10.1016/j.addbeh.2024.108136
34.
WelshJW, ShentuY, SarveyDB. Substance use among college students. Focus (Am Psychiatr Publ), 2019; 17(2):117–127; doi: 10.1176/appi.focus.20180037
35.
CarterJL, StrangJ, FrissaS, et al.; SELCoH Study Team. Comparisons of polydrug use at national and inner city levels in England: Associations with demographic and socioeconomic factors. Ann Epidemiol, 2013; 23(10):636–645; doi: 10.1016/j.annepidem.2013.07.012
36.
LalwaniK, Whitehorne-SmithP, WalcottG, et al.Prevalence and sociodemographic factors associated with polysubstance use: Analysis of a population-based survey in Jamaica. BMC Psychiatry, 2022; 22(1):513; doi: 10.1186/s12888-022-04160-2
37.
LeesB, DebenhamJ, SquegliaLM. Alcohol and cannabis use and the developing brain. Alcohol Res, 2021; 41(1):11; doi: 10.35946/arcr.v41.1.11
38.
BucknerJD, ScherzerCR, RogersAH, et al.Opioid and cannabis co-use: The role of opioid use to cope with negative affect. J Subst Use Addict Treat, 2023; 145:208942; doi: 10.1016/j.josat.2022.208942
39.
KollinsSH, SchoenfelderEN, EnglishJS, et al.An exploratory study of the combined effects of orally administered methylphenidate and delta-9-tetrahydrocannabinol (THC) on cardiovascular function, subjective effects, and performance in healthy adults. J Subst Abuse Treat, 2015; 48(1):96–103; doi: 10.1016/j.jsat.2014.07.014
40.
WickensCM, WrightM, MannRE, et al.Separate and combined effects of alcohol and cannabis on mood, subjective experience, cognition and psychomotor performance: A randomized trial. Prog Neuropsychopharmacol Biol Psychiatry, 2022; 118:110570; doi: 10.1016/j.pnpbp.2022.110570
41.
CooperZD, BediG, RameshD, et al.Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacology, 2018; 43(10):2046–2055; doi: 10.1038/s41386-018-0011-2
42.
van WelJHP, KuypersKPC, TheunissenEL, et al.Single doses of THC and cocaine decrease proficiency of impulse control in heavy cannabis users. Br J Pharmacol, 2013; 170(7):1410–1420; doi: 10.1111/bph.12425
43.
SahaS, LimCC, DegenhardtL, et al.Comorbidity between mood and substance-related disorders: A systematic review and meta-analysis. Aust N Z J Psychiatry, 2022; 56(7):757–770; doi: 10.1177/00048674211054740
44.
GroenmanAP, JanssenTWP, OosterlaanJ. Childhood psychiatric disorders as risk factor for subsequent substance abuse: A meta-analysis. J Am Acad Child Adolesc Psychiatry, 2017; 56(7):556–569; doi: 10.1016/j.jaac.2017.05.004
45.
GrantBF, StinsonFS, DawsonDA, et al.Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, 2004; 61(8):807–816; doi: 10.1001/archpsyc.61.8.807
46.
ConwayKP, ComptonW, StinsonFS, et al.Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry, 2006; 67(2):247–257; doi: 10.4088/jcp.v67n0211
47.
DegenhardtL, CharlsonF, FerrariA, et al.The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Psychiatry, 2018; 5(12):987–1012; doi: 10.1016/S2215-0366(18)30337-7
