Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

11. Polysubstance Use, Abuse, and Dependence 249dependence, which was not surveyed in the ECA, individuals with cocaineabuse/dependence have the strongest risk (84.8%; OR = 36.3) of any groupwith an SUD for an additional alcohol use disorder (Regier et al., 1990). In theECA, the associated use disorder for barbiturates, opiates, amphetamines, andhallucinogens demonstrates an OR for an additional lifetime alcohol use disorderof 10.0 or more (Regier et al., 1990).However, if one tries to understand the temporal relationship betweenclasses of substances used, lifetime diagnoses do not easily allow for the attributionthat the use of multiple substances was temporally coemergent. Therefore,using this threshold to determine multiple-substance abuse may lower its specificity,thus overestimating its prevalence. Past-year prevalence rates are morelikely than lifetime rates to provide higher specificity for identifying personswith concurrent multiple-substance use in a subpopulation identified as havingtwo or more SUDs. Unfortunately, few national surveys have presented pastyeardata on substance use comorbidity. However, data from the 11th, 12th,and 13th National Household Surveys on Drug Abuse (NHSDA; n = 87,915)offer an important source of epidemiological data on drug-related symptoms ofdependence, using criteria that can be used to approximate DSM-IV currentSUDs (Kandel, Chen, Warner, Kessler, & Grant, 1997).AdolescentsAdolescent substance users are a subgroup who have been identified as high riskfor concurrent polysubstance use, and with that, progression to hazardous use,abuse, or dependence (Brook, Brook, Zhang, Cohen, & Whiteman, 2002).Compared with older age groups, younger users in treatment settings are morelikely to report polydrug use (Substance Abuse and Mental Health ServicesAdministration [SAMHSA], 2003b). The NHSDA oversamples subjects whoare from 12 to 34 years old, offering community substance use data on adolescentswho are not typically covered in other national surveys (Kandel et al.,1997). Although males overall are more likely than females to use or be dependentupon alcohol, cannabis, or cocaine, Kandel and colleagues (1997), usingNHSDA data to determine abuse and dependence by proxy, demonstrated thatthese gender differences for rates of use and of dependence rates among usersare largely attenuated among adolescents. Adolescent girls who use alcohol orillicit drugs are at higher risk for dependence than adolescent boys, and amongfemale users of alcohol, cannabis, or cocaine, the rates of dependence are thehighest in adolescents compared with older age groups (Kandel et al., 1997).Clinical SamplesIn treatment samples, multiple SUDs are common but typically underdiagnosed(Ananth, Vandeater, Kamal, & Brodsky, 1989; Rosenthal, Hellerstein, &Miner, 1992). In general, the risk for comorbid substance use and other mental