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Trajectories of Lifetime Comorbid Alcohol and Other Drug Use Disorders Through Midlife.

OBJECTIVE
Very few studies have examined the developmental nature of comorbid alcohol use disorders and drug use disorders (AUD-DUD). The current study sought to extend our understanding of the nature of AUD-DUD comorbidity by characterizing the developmental course of AUD-DUD comorbidity, determining the degree to which the two disorders occur during the same period, and eliciting differences in AUD-DUD trajectories over the life course.


METHOD
Vietnam-era male veterans and matched civilians provided retrospective accounts of alcohol- and other drug-related experiences spanning 25 years. Concurrent growth mixture modeling was used to describe the course of AUD-DUD lifetime comorbidity.


RESULTS
Five trajectories were identified based on the probabilities of diagnosing with AUD-DUD: substance switching (increasing AUD, decreasing DUD); young adult (both AUD and DUD decreasing rapidly after young adulthood); severe nonchronic (both AUD and DUD decreasing slowly in the third decade of life); severe chronic alcohol-severe nonchronic drug (AUD remains high and DUD decreases in the fourth decade); and young adult alcohol-severe chronic drug (decreasing AUD in the second decade and DUD remains high).


CONCLUSIONS
For the majority of this sample, substance use disorders continued or worsened through adulthood, indicating a problem that extends far beyond young adulthood. Demographic characteristics differed among the trajectories; however, psychiatric diagnoses did not differ except for the number of years with diagnoses of antisocial personality disorder. Subthreshold symptoms in adulthood may be present for a significant period before diagnosis, making this period important for intervention and prevention. Integration of efforts into healthcare, employment, and public policy will help target those at highest risk.