Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder.

To characterize polysubstance addiction (PSA) patterns of cocaine use disorder (CoUD), we performed a latent class analysis (LCA) in 7,989 participants with a lifetime DSM-5 diagnosis of CoUD. This analysis identified three PSA subgroups among CoUD participants (i.e., low, 17%; intermediate, 38%; high, 45%). While these subgroups varied by age, sex, and racial-ethnic distribution (p < 0.001), there was no difference with respect to education or income (p > 0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR = 21.96 vs. 6.39, difference-p = 8.08✕10), agoraphobia (OR = 4.58 vs. 2.05, difference-p = 7.04✕10), mixed bipolar episode (OR = 10.36 vs. 2.61, difference-p = 7.04✕10), posttraumatic stress disorder (OR = 11.54 vs. 5.86, difference-p = 2.67✕10), antidepressant medication use (OR = 13.49 vs. 8.02, difference-p = 1.42✕10), and sexually transmitted diseases (OR = 5.92 vs. 3.38, difference-p = 1.81✕10) than the low-PSA CoUD subgroup. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.