People often use substances to cope with intense emotions, but more research is needed in this area. The scale we used to measure affect intensity was the Affect Intensity Measure (AIM). The participants self-reported their substance use. Drawing from a sample of adults in substance use treatment (n=118), we used regression analysis to examine the relationship between affect intensity, drug use motivations, and polysubstance use. Having this information is crucial to understanding how emotional experiences can be related to substance use. By knowing this we can also alter treatment to be specific to the individual, in order to improve the success rate of treatment facilities. More research is needed examining the relationship between affect intensity, motivation for substance use, and substance use patterns among people who are receiving substance use treatment.

The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by the Gelberg Behavioral Model of Vulnerable Populations. This project utilizes secondary data from the Criminal Justice Kentucky Treatment Outcome Study, a Kentucky Department of Corrections funded two-wave longitudinal study of individuals who participated in substance abuse treatment programming while incarcerated. Latent profile analysis is used to determine the patterns of pre-incarceration opioid PSU in aim 1. Analyses for aims 2 and 3 examine PSU profiles, along with variables drawn from the Behavioral Model for Vulnerable Populations, in order to predict important reentry outcomes of relapse and health service utilization 12-months post-release in a series of logistic regressions. Six unique profiles of opioid PSU were found among the current justice-involved population, which faced disproportionate risk of adverse outcomes at follow-up. Findings indicate heterogeneity of opioid use among a justice-involved population. The role of mental and physical health in PSU severity is also highlighted. Further, results from post-release analyses indicate that a continuum of risk exists among PSU such that PSU patterns are unique and important predictors of post-release outcomes which can be used to inform interventions during incarceration. The importance of accounting for vulnerability as conceptualized in the Behavioral Model for Vulnerable Populations is also discussed.

Alcohol is among the most common substance to be co-administered with a variety of other drugs. It is frequently used simultaneously (i.e., on the same occasion) with cocaine. The objective of this qualitative investigation was to explore the patterns, contexts, functions, harmful consequences, risk-taking behaviors, and gender differences associated with the simultaneous use of cocaine and alcohol. In-depth semi-structured interviews with simultaneous alcohol and cocaine users were conducted at a residential treatment centre in Ontario, Canada (n=10). Two independent coders conducted a content analysis of the transcripts. Results revealed that method of cocaine use was an important variable when describing a simultaneous use occasion. There was a wide variety of reported contexts, functions, and harms associated with simultaneous alcohol and cocaine use. This research contributes to a better understanding of the patterns, functions, and contexts of simultaneous use, along with the corresponding risk taking behaviors and harms in treatment clients.

This mixed-methods dissertation considers the experiences of women who used substances during pregnancy. Retrospective interviews with 15 women, currently accessing inpatient substance abuse treatment, identify trends in women’s experiences prior to accessing these services. Women report being concerned about the impact of their substance use on the developing baby, seeking information, reducing substance use outside of accessing treatment services, and engaging in healthy behaviors to protect the baby from harm. Trends related to trying to reduce harm to the baby during pregnancy are then further explored through quantitative analyses. Data on harm reduction behaviors prior to accessing treatment were collected from an additional 54 women. A clinical and research tool for visually tracking patterns of maternal substance use over the course of pregnancy was developed. This tool identifies the high prevalence of women who decrease their substance use during pregnancy outside of accessing treatment services. Clinical use of this tool is considered. In addition, a questionnaire, designed to identify engagement in harm reduction and health promoting behaviors, was administered. Data suggests that harm reduction and health promotion behaviors are common and tend to begin early on in pregnancy. Women report beginning to decrease their substance use, on average, beginning at the end of the first trimester. The timing of beginning to reduce substance use is not associated with the timing of entering substance abuse treatment in relation to a given pregnancy. However, maternal mental health and perceived barriers to accessing services do predict when, in relation to pregnancy, women enter treatment. As a whole, this research suggests that continued use of substances during pregnancy is not due to indifference towards the developing baby. Instead, women report being concerned about their babies and being engaged in the process of positive self-change. There are public health and clinical implications to these findings. This research suggests the opportunity to build upon the motivation that women have to decrease their substance use. In addition, this research suggests the importance of focusing policy and intervention efforts on addressing perceived barriers to accessing treatment services.

Indiana University-Purdue University Indianapolis (IUPUI) / Rates of vaping among high school students have increased significantly over the past decade. Prior research has found significant associations between youth vaping and substance use. However, little is known about how vaping is associated with various patterns of polysubstance use and asthma in youth. We aimed to identify how youth are best categorized into classes based on co-occurring vaping and polysubstance use behaviors, how these classes are associated with youth background and demographic characteristics, and if these classes significantly predict asthma outcomes. Our sample consisted of nationally representative data from the 2017 and 2019 waves of the Youth Risk Behavior Survey (N = 28,442). We utilized Latent Class Analysis, multinomial logistic regression analyses, and binary logistic regression analyses to examine relationships between youth vaping, polysubstance use, and asthma. Three latent classes of substance use were identified: Polysubstance Users, Lifetime Alcohol and Vape Users, and Abstainers. Age, gender, grade and race were all significantly associated with odds of membership in the Polysubstance Users class, compared to the Abstainers class. Sexual identity was not associated with class membership. Membership in the Polysubstance Users class was significantly associated with higher odds of asthma, as compared to membership in the other two classes. These findings indicate that recent vaping is associated with high probabilities of recent polysubstance use. They also suggest that youth with high probabilities of vaping and polysubstance use are at significantly high risk for asthma compared to other classes vi of youth users and non-users. We recommend that future youth intervention strategies be tailored differently toward different classes of substance use and vaping. Future research should examine how the classes of vaping and substance use that we identify emerge in youth and what social factors (e.g., peer behavior, parental connectedness, etc.) influence their development.

This study examined the associations of polysubstance use, mood disorders, and chronic conditions with the history of anxiety disorder among patients with opioid use disorder (OUD). We performed a secondary analysis of the baseline data from a clinical trial including 1,645 individuals with OUD, of which 513 had anxiety disorder. Substance use disorders (SUDs) included alcohol, amphetamines, cannabis, cocaine, and sedative use disorders. Mood disorders included major depressive disorder (MDD) and bipolar disorder (BD). Chronic conditions were allergies, gastrointestinal problem(s), skin problem(s), and hypertension. Sedative use disorder, MDD, BD, skin problems, and hypertension were significantly associated with anxiety disorder (p < 0.05). Additionally, more than two SUDs, two mood disorders, and more than two chronic conditions were significantly associated with anxiety disorder (p < 0.05). These findings highlight the comorbid mental health and physical health problems in individuals with OUD, as well as the need for integrated multidisciplinary treatment plans.

Contexte : Les études sur la consommation de substances en lien avec la santé mentale chez les jeunes adultes considèrent généralement chaque substance séparément et se concentrent sur les symptômes d'anxiété ou de dépression. Ce mémoire décrit les modes de consommation régulière (au moins hebdomadaire) d'alcool, de cannabis et de nicotine et estime l'association entre ces modes de consommation (séparément et en combinaison) et les symptômes de dépression, d’anxiété ainsi que la santé mentale positive (SMP) chez les jeunes adultes. Méthodes : Les données de cette étude transversale sont tirées du cycle 23 (2017-20) de l'étude NDIT, lorsque les participants étaient âgés de 31 ans en moyenne. Une régression linéaire ajustée pour l'âge, le sexe et le niveau d'éducation modélise les associations entre: (i) le nombre de substances consommées; et (ii) les modes de consommation de plusieurs substances et chacun des indicateurs de santé mentale. Résultats : 37 % des participants n’ont consommé aucune substance régulièrement; 42 %, 16 % et 5 % ont consommé une, deux et trois substances, respectivement. Il n'y avait pas d'association dose-réponse entre le nombre de substances et les indicateurs de santé mentale. La consommation de deux substances était associée aux symptômes d'anxiété (β ̂(IC95%) = 1,32(0,34;2,31) et à la SMP (-3,64(-6,34;-0,95)). La combinaison cannabis-nicotine était associée aux symptômes d'anxiété (2,58(1,06;4,10)) et à la SMP (-5,90(-10,04;-1,76)). La combinaison alcool-nicotine était associée à la SMP (-3,70(-7,30,-0,10)). Conclusion : Les combinaisons de substances en plus des substances individuelles devraient être investiguées en lien avec la santé mentale. / Background: Studies on substance use in relation to mental health among young adults generally consider each substance separately and in addition, they tend to focus on symptoms of anxiety or depression. This thesis describes the patterns of regular (at least weekly) use of alcohol, cannabis and nicotine, and estimates the association between these patterns and symptoms of depression, anxiety, as well as positive mental health (PMH) among young adults. Methods: Data for this cross-sectional study were drawn from cycle 23 (2017-20) of the NDIT study when participants were age 31 years on average. The associations between: (i) number of substances used; and (ii) pattern of polysubstance use and each of the mental health indicators were modeled using linear regression adjusting for age, sex and level of education. Results: 37% of participants did not consume any substances regularly; 42%, 16%, and 5% consumed one, two and three substances, respectively. There was no dose response association between number of substances and any of the mental health indicators. Use of two substances was associated with anxiety symptoms (β ̂(95% CI) = 1.32(0.34,2.31)) and PMH (-3.64(-6.34,-0.95)). The cannabis-nicotine combination was associated with anxiety symptoms (2.58(1.06,4.10)) and PMH (-5.90(-10.04,-1.76)). The alcohol-nicotine combination was associated with PMH (-3.70(-7.30,-0.10)). Conclusion: Combinations of specific substances in addition to individual substances should be investigated in relation to mental health among young adults.

Background: Polysubstance use (PSU) is common among patients with cannabis use (CU) and is related to more severe CU problems. However, it is unclear how PSU predicts CU treatment outcomes beyond CU patterns. We examined the frequency, amount, and class of additionally used substances as predictors for primary and secondary outcomes. Methods: We conducted crude and adjusted regression analyses for PSU variables as predictors of remission, abstinence, reduction, and secondary outcomes in 166 help-seeking patients from a randomized clinical trial of CANDIS, a cognitive behavioral treatment program. Results: Patients with recent illegal PSU experienced more difficulties in reducing their CU (B = –1.22, p < 0.001). In contrast, remission rates were slightly higher in patients with a wide variety of last-year-PSU (RD = 0.04, p < 0.001). Amphetamine use predicted poorer outcomes regarding CU-related problems (B = –4.22, p = 0.019), and the use of opiates, inhalants, and dissociative substances predicted poorer physical health outcomes (B = –0.62, p = 0.009; B = –0.96, p = 0.039; B = –1.18, p = 0.007). Conclusions: CU treatment is also effective for patients with moderate PSU. However, treatment effects may be enhanced by addressing specific PSU characteristics as part of a modularized program.