Are you thinking what I’m thinking? Defining what we mean by “polysubstance use.”

ABSTRACT

The rise in drug overdoses and harms associated with the use of more than one substance has led to increased use of the term “polysubstance use” among researchers, clinicians, and public health officials. However, the term retains no consistent definition across contexts. The current authors convened from disciplines including sociology, epidemiology, neuroscience, and addiction psychiatry to propose a recommended definition of polysubstance use. An iterative process considered authors’ formal and informal conversations, insights from relevant symposia, talks, and conferences, as well as their own research and clinical experiences to propose the current definition. Three key concepts were identified as necessary to define polysubstance use: (1) substances involved, (2) timing, and (3) intent. Substances involved include clarifying either (1) the number and type of substances used, (2) presence of more than one substance use disorder, or (3) primary and secondary substance use. The concept of timing is recommended to use clear terms such as simultaneous, sequential, and same-day polysubstance use to describe short-term behaviors (e.g., 30-day windows). Finally, the concept of intent refers to clarifying unintentional use or exposure when possible, and greater attention to motivations of polysubstance use. These three components should be clearly defined in research on polysubstance use to improve consistency across disciplines. Consistent definitions of polysubstance use can aid in the synthesis of evidence to better address an overdose crisis that increasingly involves multiple substances.

KEYWORDS:

• Polysubstance use
• concept
• measurement
• substance use disorder

Acknowledgments

We gratefully acknowledge Robert Raffa, Jason Ford, Abby Jones, Julian Santaella, Meredith Meacham.

Disclosure statement

ARW – receives consulting fees, equity, and travel expenses from Ophelia Health, Inc. a telehealth company for the treatment of opioid use disorder. SDC has received research funding within the past 3 years from Alkermes, BioXcel, Go Medical, Intra-cellular Therapies, Janssen, and Lyndra. SDC has also consulted for Alkermes, Opiant, and Syneos Health.

The remaining authors have no conflicts of interest to declare.

Additional information

Funding

AMB – R13DA057083; K01DA053435; RDS – T32GM008244; ARW – R01 DA057566; R01 DA059042; ALC- K01AA026854; JL – R01DA049761; SDC – UH3DA047711; UG3DA056247