The prevalence of opioid use disorder has substantially risen over the past 15 years (Martins et al., 2017); however, alcohol remains the most commonly used substance in the U.S. Effects of alcohol and drugs are compounded when used concurrently (Mccabe et al., 2006) in a way that increases the risk for overdose and other harms (Subbaraman et al., 2015). Although there has been some exploration of factors associated with concurrent polydrug use of alcohol and other drugs, this study uses a recent statewide sample to explore factors associated with concurrent polydrug use involving alcohol and another drug on the same day.
The Government Performance and Results Modernization Act (GPRA) intake assessments for clients receiving treatment or recovery services (e.g., substance use treatment, recovery planning, peer recovery coaching) funded by the Michigan Opioid Response grant (June 2019 to September 2021) were analyzed (N=3,384). Demographic measures (race, ethnicity, gender, and housing status), substance use-related variables (binge drinking, marijuana use, injection drugs use, cocaine/crack use, methamphetamines/amphetamines use, concurrent polydrug use), and depression were assessed. Multivariable logistic regression was used to identify factors associated with concurrent polydrug use.
Participants were predominantly male (63.5%), White (83.1%), and non-Hispanic (95.6%). Results show 86.7% of clients reported concurrent polydrug use in the past month; 69.2% of clients reported binge drinking, 20.6% used marijuana, 17.2% used injection drugs, 14.6% used cocaine/crack, and 10.9% used methamphetamines or other amphetamines. The multivariable logistic regression model was significant (R2=.242, p<.001). Clients who identified as Black had greater odds of concurrent polydrug use (OR= 4.271, p=.028) than clients who were White or other People of Color. Clients who reported binge drinking (OR=4.141, p<.001) and cocaine/crack (OR=3.755, p=.002) had greater odds of concurrent polydrug use.
Conclusions and Implications
The majority of adults in this sample reported concurrent use of alcohol and other drugs. Given the increased risk for overdose associated with concurrent polydrug use, harm reduction interventions that address concurrent use may be an effective strategy to prevent overdoses. These interventions could educate clients about different substances' half-lives and encourage them never to use drugs alone. Given the association between binge drinking and concurrent polydrug use, clients should also be educated about the dose-response relationship between alcohol intake and the risk for harm associated with concurrent use. Concurrent polydrug use was more common among clients who used cocaine/crack. While it may be assumed that combining alcohol (a depressant) with a stimulant may be safer than combining two depressants, mixing cocaine/crack with alcohol carries substantial risk. Treatment programs should directly address this misconception. Concurrent polydrug use was also more common among clients who identified as Black. Harm reduction may be particularly important for this population to reverse rapidly rising overdose death rates among communities of Color. As one of the primary service providers for people with substance use disorder, social workers need to be prepared to assess for and intervene around concurrent polydrug use.