Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder

Brendan Stiltner; Robert H Pietrzak; Daniel S Tylee; Yaira Z Nunez; Keyrun Adhikari; Henry R Kranzler; Joel Gelernter; Renato Polimanti

doi:10.1016/j.isci.2023.107336

Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder

iScience. 2023 Jul 16;26(8):107336. doi: 10.1016/j.isci.2023.107336. eCollection 2023 Aug 18.

Authors

Brendan Stiltner^{1

2}, Robert H Pietrzak^{1

3}, Daniel S Tylee^{1

2}, Yaira Z Nunez^{1

2}, Keyrun Adhikari^{1

2}, Henry R Kranzler^{4

5}, Joel Gelernter^{1

2}, Renato Polimanti^{1

2}

Affiliations

¹ Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA.
² VA Connecticut Healthcare System, West Haven, CT 06516, USA.
³ U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
⁴ University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
⁵ Mental Illness Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA.

Abstract

To characterize polysubstance addiction (PSA) patterns of cocaine use disorder (CoUD), we performed a latent class analysis (LCA) in 7,989 participants with a lifetime DSM-5 diagnosis of CoUD. This analysis identified three PSA subgroups among CoUD participants (i.e., low, 17%; intermediate, 38%; high, 45%). While these subgroups varied by age, sex, and racial-ethnic distribution (p < 0.001), there was no difference with respect to education or income (p > 0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR = 21.96 vs. 6.39, difference-p = 8.08✕10^-6), agoraphobia (OR = 4.58 vs. 2.05, difference-p = 7.04✕10^-4), mixed bipolar episode (OR = 10.36 vs. 2.61, difference-p = 7.04✕10^-4), posttraumatic stress disorder (OR = 11.54 vs. 5.86, difference-p = 2.67✕10^-4), antidepressant medication use (OR = 13.49 vs. 8.02, difference-p = 1.42✕10^-4), and sexually transmitted diseases (OR = 5.92 vs. 3.38, difference-p = 1.81✕10^-5) than the low-PSA CoUD subgroup. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.

Keywords: Addiction medicine; Socioeconomic status.

Abstract

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