Prevention Science

, Volume 20, Issue 5, pp 695–704 | Cite as

Factors Associated with Poly Drug Use in Adolescents

  • Michelle JongenelisEmail author
  • Simone Pettigrew
  • David Lawrence
  • Wavne Rikkers


Poly drug use in adolescents represents a significant public health issue, heightening risk for abuse, dependency, and a variety of short- and long-term psychological, psychosocial, and health consequences. However, past studies have typically examined just one or two substances in isolation and there is a lack of research that has comprehensively examined possible predictors of poly drug use in adolescents. To inform the development of comprehensive prevention programs that can simultaneously target multiple substances, the present study sought to identify psychological, environmental, and demographic factors that are most strongly associated with alcohol, tobacco, and cannabis poly drug use. Adolescents aged 15 to 17 years (n = 1661; 50.9% male) completed a survey on their use of alcohol, tobacco, and cannabis over the last 30 days. Various psychological, environmental, and demographic factors were also assessed. Weighted multiple-level logistic regression was conducted to assess the factors associated with poly drug use. In total, 20.3% of respondents had used at least one substance, 6.7% reported using two substances, and 3.3% reported using all three substances. The most common combined pattern of use was alcohol and tobacco, followed by alcohol and cannabis. Several factors emerged as significant, with conduct problems, depression, and the school environment accounting for the most variance. Specific psychological and environmental factors appear to be particularly important domains to target in adolescent substance use prevention programs. Early identification of adolescent depression and conduct problems and the development of programs that address these symptoms in youth may be effective approaches to delaying or preventing poly drug use in this population.


Poly drug use Alcohol Tobacco Cannabis Adolescents Prevention 



Young Minds Matter: the second Australian Child and Adolescent Survey of Mental Health and Wellbeing was funded by the Australian Government Department of Health. No specific funding was received for this analysis.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement on the Welfare of Animals

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Ainley, J., & Bourke, S. (1992). Student views of primary schooling. Research Papers in Education, 87, 107–128.CrossRefGoogle Scholar
  2. Ashtari, M., Avants, B., Cyckowski, L., Cervellione, K. L., Roofeh, D., Cook, P., . . . Kumra, S. (2011). Medial temporal structures and memory functions in adolescents with heavy cannabis use. Journal of Psychiatric Research, 45, 1055–1066.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Australian Bureau of Statistics. (2011). SEIFA Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. (Cat. no. 2033.0.55.001). Canberra: ABS.Google Scholar
  4. Australian Bureau of Statistics. (2014). Australian demographic statistics. (Cat. no. 3101.0). Canberra: ABS.Google Scholar
  5. Bohnert, K. M., Walton, M. A., Resko, S., Barry, K. T., Chermack, S. T., Zucker, R. A., et al. (2014). Latent class analysis of substance use among adolescents presenting to urban primary care clinics. The American Journal of Drug and Alcohol Abuse, 40, 44–50.CrossRefPubMedGoogle Scholar
  6. Bond, L., Butler, H., Thomas, L., Carlin, J., Glover, S., Bowes, G., & Patton, G. (2007). Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. Journal of Adolescent Health, 40, 357.e359–357.e318.CrossRefGoogle Scholar
  7. Busch, V., Van Stel, H. F., Schrijvers, A. J., & de Leeuw, J. R. (2013). Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: A cross-sectional study. BMC Public Health, 13, 1118–1128.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Camenga, D. R., Klein, J. D., & Roy, J. (2006). The changing risk profile of the American adolescent smoker: Implications for prevention programs and tobacco interventions. Journal of Adolescent Health, 39, 120.e121–120.e110.CrossRefGoogle Scholar
  9. Connell, C. M., Gilreath, T. D., & Hansen, N. B. (2009). A multiprocess latent class analysis of the co-occurrence of substance use and sexual risk behavior among adolescents. Journal of Studies on Alcohol and Drugs, 70, 943–951.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Cooke, R., Dahdah, M., Norman, P., & French, D. P. (2016). How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis. Health Psychology Review, 10, 148–167.CrossRefPubMedGoogle Scholar
  11. Dwyer, J. B., McQuown, S. C., & Leslie, F. M. (2009). The dynamic effects of nicotine on the developing brain. Pharmacology & Therapeutics, 122(2), 125–139.CrossRefGoogle Scholar
  12. Ewing, S. W. F., Sakhardande, A., & Blakemore, S. J. (2014). The effect of alcohol consumption on the adolescent brain: A systematic review of MRI and fMRI studies of alcohol-using youth. NeuroImage: Clinical, 5, 420–437.CrossRefGoogle Scholar
  13. Fallu, J. S., Brière, F. N., & Janosz, M. (2014). Latent classes of substance use in adolescent cannabis users: Predictors and subsequent substance-related harm. Frontiers in Psychology, 5.
  14. Felton, J. W., Kofler, M. J., Lopez, C. M., Saunders, B. E., & Kilpatrick, D. G. (2015). The emergence of co-occurring adolescent polysubstance use and depressive symptoms: A latent growth modeling approach. Development and Psychopathology, 27, 1367–1383.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Foxcroft, D. R., & Tsertsvadze, A. (2012). Cochrane review: Universal school-based prevention programs for alcohol misuse in young people. Evidence-Based Child Health: A Cochrane Review Journal, 7, 450–575.CrossRefGoogle Scholar
  16. Goodman, R. (1994). A modified version of the Rutter parent questionnaire including extra items on children’s strengths: A research note. Journal of Child Psychology and Psychiatry, 35, 1483–1494.CrossRefPubMedGoogle Scholar
  17. Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1337–1345.CrossRefGoogle Scholar
  18. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19, 505–526.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Grigsby, T. J., Forster, M., Unger, J. B., & Sussman, S. (2016). Predictors of alcohol-related negative consequences in adolescents: A systematic review of the literature and implications for future research. Journal of Adolescence, 48, 18–35.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Hafekost, J., Lawrence, D., Boterhoven de Haan, K., Johnson, S. E., Saw, S., Buckingham, W. J., et al. (2016). Methodology of young minds matter: The second Australian child and adolescent survey of mental health and wellbeing. Australian & New Zealand Journal of Psychiatry, 50, 866–875.CrossRefGoogle Scholar
  21. Hafekost, K., Boterhoven de Haan, K., Lawrence, D., Sawyer, M. G., & Zubrick, S. R. (2017). Validation of the Adolescent Self-Esteem Questionnaire: Technical report. Perth, Australia: Telethon Kids Institute and the Graduate School of Education, The University of Western Australia.Google Scholar
  22. Hale, D. R., Fitzgerald-Yau, N., & Viner, R. M. (2014). A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence. American Journal of Public Health, 104, e19–e41.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Harris, K. M., & Udry, J. R. (1994-2008). National longitudinal study of adolescent health (add health), 1994-2008; wave 1 public use data, Data collection instrument and users guide. Retrieved from Accessed 1 Sept 2017.
  24. Hublet, A., Bendtsen, P., de Looze, M. E., Fotiou, A., Donnelly, P., Vilhjalmsson, R., et al. (2015). Trends in the co-occurrence of tobacco and cannabis use in 15-year-olds from 2002 to 2010 in 28 countries of Europe and North America. The European Journal of Public Health, 25, 73–75.CrossRefPubMedGoogle Scholar
  25. Jacobus, J., Bava, S., Cohen-Zion, M., Mahmood, O., & Tapert, S. F. (2009). Functional consequences of marijuana use in adolescents. Pharmacology Biochemistry and Behavior, 92(4), 559–565.CrossRefGoogle Scholar
  26. Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the future national survey results on drug use: 1975–2014: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan Retrieved from Accessed 1 Sept 2017.
  27. Kelly, A. B., Chan, G. C., Mason, W. A., & Williams, J. W. (2015a). The relationship between psychological distress and adolescent polydrug use. Psychology of Addictive Behaviors, 29, 787–793.CrossRefPubMedGoogle Scholar
  28. Kelly, A. B., Evans-Whipp, T. J., Smith, R., Chan, G. C., Toumbourou, J. W., Patton, G. C., et al. (2015b). A longitudinal study of the association of adolescent polydrug use, alcohol use and high school non-completion. Addiction, 110, 627–635.CrossRefPubMedPubMedCentralGoogle Scholar
  29. King, S. M., Iacono, W. G., & McGue, M. (2004). Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction, 99, 1548–1559.CrossRefGoogle Scholar
  30. Leatherdale, S. T., & Ahmed, R. (2010). Alcohol, marijuana, and tobacco use among Canadian youth: Do we need more multi-substance prevention programming? The Journal of Primary Prevention, 31, 99–108.CrossRefPubMedGoogle Scholar
  31. Leatherdale, S. T., Hammond, D., & Ahmed, R. (2008). Alcohol, marijuana, and tobacco use patterns among youth in Canada. Cancer Causes & Control, 19, 361–369.CrossRefGoogle Scholar
  32. Li, Y., Zhang, W., Liu, J., Arbeit, M. R., Schwartz, S. J., Bowers, E. P., & Lerner, R. M. (2011). The role of school engagement in preventing adolescent delinquency and substance use: A survival analysis. Journal of Adolescence, 34, 1181–1192.CrossRefGoogle Scholar
  33. Lisdahl, K. M., Gilbart, E. R., Wright, N. E., & Shollenbarger, S. (2013). Dare to delay? The impacts of adolescent alcohol and marijuana use onset on cognition, brain structure, and function. Frontiers in Psychiatry, 4.
  34. Marshall, E. J. (2014). Adolescent alcohol use: Risks and consequences. Alcohol and Alcoholism, 49, 160–164.CrossRefPubMedGoogle Scholar
  35. Maslowsky, J., & Schulenberg, J. E. (2013). Interaction matters: Quantifying conduct problem× depressive symptoms interaction and its association with adolescent alcohol, cigarette, and marijuana use in a national sample. Development and Psychopathology, 25, 1029–1043.CrossRefPubMedGoogle Scholar
  36. Matuszka, B., Bácskai, E., Czobor, P., & Gerevich, J. (2017). Physical aggression and concurrent alcohol and tobacco use among adolescents. International Journal of Mental Health and Addiction, 15, 90–99.CrossRefGoogle Scholar
  37. Peters, E. N., Budney, A. J., & Carroll, K. M. (2012). Clinical correlates of co-occurring cannabis and tobacco use: A systematic review. Addiction, 107(8), 1404–1417.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Reyes, J. C., Perez, C. M., Colón, H. M., Dowell, M. H., & Cumsille, F. (2013). Prevalence and patterns of polydrug use in Latin America: Analysis of population-based surveys in six countries. Review of European Studies, 5, 10–18.CrossRefGoogle Scholar
  39. Scheier, L. M., Botvin, G. J., Griffin, K. W., & Diaz, T. (2000). Dynamic growth models of self-esteem and adolescent alcohol use. The Journal of Early Adolescence, 20, 178–209.CrossRefGoogle Scholar
  40. Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 28–38.CrossRefGoogle Scholar
  41. Shortt, A. L., Hutchinson, D. M., Chapman, R., & Toumbourou, J. W. (2007). Family, school, peer and individual influences on early adolescent alcohol use: First-year impact of the Resilient Families programme. Drug and Alcohol Review, 26, 625–634.CrossRefGoogle Scholar
  42. Spear, L. (2000). Modeling adolescent development and alcohol. Alcohol Research & Health, 24, 115–123.Google Scholar
  43. Stapinski, L. A., Edwards, A. C., Hickman, M., Araya, R., Teesson, M., Newton, N. C., et al. (2016). Drinking to cope: A latent class analysis of coping motives for alcohol use in a large cohort of adolescents. Prevention Science, 17, 584–594.CrossRefPubMedGoogle Scholar
  44. Telethon Kids Institute. (2015). Young minds matter: the second Australian Child and Adolescent Survey of Mental Health and Wellbeing, Survey User’s Guide. Centre for Child Health Research, University of Western Australia. Retrieved from Accessed 1 Sept 2017.
  45. Tomczyk, S., Isensee, B., & Hanewinkel, R. (2016). Latent classes of polysubstance use among adolescents—A systematic review. Drug and Alcohol Dependence, 160, 12–29.CrossRefGoogle Scholar
  46. Veselska, Z., Geckova, A. M., Orosova, O., Gajdosova, B., van Dijk, J. P., & Reijneveld, S. A. (2009). Self-esteem and resilience: The connection with risky behavior among adolescents. Addictive Behaviors, 34, 287–291.CrossRefGoogle Scholar
  47. White, V., & Williams, T. (2016). Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2014. Melbourne: Centre for Behavioural Research in Cancer, Cancer Council Victoria. Retrieved from$File/National-report_ASSAD_2014.pdf. Accessed 1 Sept 2017.
  48. Wiefferink, C. H., Peters, L., Hoekstra, F., Ten Dam, G., Buijs, G. J., & Paulussen, T. G. (2006). Clustering of health-related behaviors and their determinants: Possible consequences for school health interventions. Prevention Science, 7, 127–149.CrossRefPubMedGoogle Scholar
  49. Wilson, W., Mathew, R., Turkington, T., Hawk, T., Coleman, R. E., & Provenzale, J. (2000). Brain morphological changes and early marijuana use: A magnetic resonance and positron emission tomography study. Journal of Addictive Diseases, 19, 1–22.CrossRefPubMedGoogle Scholar

Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  1. 1.School of PsychologyCurtin UniversityPerthAustralia
  2. 2.Graduate School of EducationThe University of Western AustraliaPerthAustralia

Personalised recommendations