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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ainley, J., & Bourke, S. (1992). Student views of primary schooling. Research Papers in Education, 87, 107–128.
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.
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.
Australian Bureau of Statistics. (2014). Australian demographic statistics. (Cat. no. 3101.0). Canberra: ABS.
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.
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.
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.
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.
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.
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.
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.
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.
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. https://doi.org/10.3389/fpsyt.2014.00009.
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.
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.
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.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1337–1345.
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.
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.
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.
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.
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.
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 https://statacumen.com/teach/ADA1/PDS_data/AddHealthW1_CodeBook.pdf. Accessed 1 Sept 2017.
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.
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.
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 http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2014.pdf. Accessed 1 Sept 2017.
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.
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.
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.
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.
Leatherdale, S. T., Hammond, D., & Ahmed, R. (2008). Alcohol, marijuana, and tobacco use patterns among youth in Canada. Cancer Causes & Control, 19, 361–369.
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.
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. https://doi.org/10.3389/fpsyt.2013.00053.
Marshall, E. J. (2014). Adolescent alcohol use: Risks and consequences. Alcohol and Alcoholism, 49, 160–164.
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.
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.
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.
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.
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.
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.
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.
Spear, L. (2000). Modeling adolescent development and alcohol. Alcohol Research & Health, 24, 115–123.
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.
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 https://youngmindsmatter.telethonkids.org.au/globalassets/subsite-media/subsite-documents/young-minds-matter/survey-user-s-guide-final.pdf. Accessed 1 Sept 2017.
Tomczyk, S., Isensee, B., & Hanewinkel, R. (2016). Latent classes of polysubstance use among adolescents—A systematic review. Drug and Alcohol Dependence, 160, 12–29.
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.
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 http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/$File/National-report_ASSAD_2014.pdf. Accessed 1 Sept 2017.
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.
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.
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.
Conflict of Interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Jongenelis, M., Pettigrew, S., Lawrence, D. et al. Factors Associated with Poly Drug Use in Adolescents. Prev Sci 20, 695–704 (2019). https://doi.org/10.1007/s11121-019-00993-8
- Poly drug use