Identifying subtypes of cannabis users based on simultaneous polysubstance use

Abstract

Background: Cannabis use patterns vary considerably, with many users reporting simultaneous and non-simultaneous use (co-use) of other substances. Despite this, little research has examined the extent to which subtypes of cannabis users may be identified based on their simultaneous and co-use behaviors.

Methods: The sample consisted of adult Australian twins and siblings who reported lifetime cannabis use (n = 2590). A latent class analysis was conducted to determine subtypes of cannabis users based on five indicators of substance co-use and simultaneous use. Adolescent correlates (age of substance initiation and conduct disorder) and adult correlates (substance use/disorder and depression) of class membership were assessed. Twin similarity for class membership was also examined.

Results: Four subtypes of users were identified: 1) alcohol co-users, 2) simultaneous alcohol users, 3) simultaneous tobacco users, and 4) simultaneous alcohol, tobacco, and drug users. Compared to co-users of alcohol, simultaneous alcohol users were at increased risk for alcohol problems. Patterns of use that involved simultaneous tobacco and cannabis use (i.e., simultaneous tobacco users and simultaneous alcohol, tobacco, and drug users) were associated with the most problematic outcomes, including substance use and disorder. There was evidence for genetic influences (12-58%) on cannabis use patterns, with higher concordance for latent class membership among monozygotic compared to dizygotic twins (χ2 (1) = 7.19, p = 0.007).

Conclusions: The current study identified four classes of cannabis users at varying degrees of risk. Results suggest that simultaneous tobacco and cannabis use may be especially associated with deleterious outcomes.

Keywords: Cannabis; Co-use; Latent class analysis; Simultaneous polysubstance use.

Conflict of interest statement

Conflict of Interest: No conflict declared.

Copyright © 2019 Elsevier B.V. All rights reserved.

Figures

Figure 1.

Symptom endorsement profiles by latent class membership. Note: Sim. = simultaneous, ALC = alcohol, TOB = tobacco, ATD = alcohol, tobacco, and drugs. Dashed lines indicate simultaneous user classes, while the solid line indicates the co-user class. Square markers indicate classes where alcohol is the primary substance used, and triangle markers indicate classes involving simultaneous tobacco use.

Figure 2.

Cannabis use outcomes across latent classes. Note: Error bars indicate standard errors. Sim. = simultaneous, ATD = alcohol, tobacco, and drugs, CUD = cannabis use disorder. Extent of use was coded such that 1 indicates using marijuana once, 2 indicates using twice, 3 indicates using 3-10 times, 4 indicates using 11-29 times, and 5 indicates using 30 or more times. Initial liking was coded such that 0 indicates initially liking cannabis ‘not at all’, 1 indicates liking ‘a little’, 2 indicates liking ‘some,’ and 3 indicates liking ‘a lot’. Color figure available online.