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

11. Polysubstance Use, Abuse, and Dependence 251ment (Rosenthal & Westreich, 1999). Patients with multiple SUDs have greaterdifficulty achieving remission in intensive addiction treatment (Ritsher, Moos,& Finney, 2002). In addition, a history of multiple substance use predicts relapseto drugs in addiction treatment follow-up studies (Walton, Blow, & Booth,2000). Among patients in treatment for SUDs in a 2-year follow-up study byWalton and colleagues (2000), subjects (n = 241) self-reported their current primarysubstances of choice. Forty-one percent indicated alcohol as the sole drug ofabuse. Among the 59.1% who were polysubstance users, the drugs of choice werealcohol, 79.1%; cocaine, 72.7%; marijuana, 48.2%; opiates, 16.5%; sedatives,13.7%; stimulants, 8.6%; heroin, 9.4%; and hallucinogens, 5.0%.Nicotine and Multiple Substance Use DisordersNicotine dependence has not been traditionally thought of in the context oftreating drug abuse problems, even among clinicians trained in addiction treatment.Consequently, when multiple SUDs are discussed, they usually do notinclude whether the person referred to is a habitual smoker. Nonetheless, over90% of patients in methadone maintenance treatment are current tobaccosmokers, a reasonable proxy for nicotine dependence (Clemmey, Brooner,Chutuape, Kidorf, & Stitzer, 1997). Similarly, 90% of patients in alcoholisminpatient treatment are current smokers (Beatty, Blanco, Hames, & Nixon,1997). Thus, even among patients identified as having only one current SUD,these individuals are, in fact, multiply drug dependent.Multiple Substance Use among AlcoholicsThe concurrent abuse of alcohol and drugs is a significant problem. Alcoholand drug use disorders frequently overlap, and there are high rates of nonalcoholSUDs among patients in treatment for alcohol use disorders (Beatty etal., 1997). In the 2001 TEDS sample, 72% of all persons admitted to treatmentreported alcohol as a primary or secondary substance; 22% of addiction treatmentadmissions reported primary drug abuse with secondary alcohol abuse, and20% reported primary alcohol abuse with secondary drug abuse (SAMHSA,2003b).Multiple Substance Use among Injecting Heroin UsersInjection drug use is highly correlated with use of multiple substances. Injectingheroin users frequently use multiple drugs in addition to nicotine, such as alcohol,benzodiazepines, cannabis, and amphetamines, and there do not appear tobe differences between treatment and nontreatment samples with regard to thenumber of either lifetime or current dependence diagnoses (Darke & Ross,1997; Dinwiddie, Cottler, Compton, & Abdallah, 1996; Kidorf, Brooner, King,Chutuape, & Stitzer, 1996). Darke and Ross (1997) recruited a nonrandom