title: Clinical characteristics of alcohol combined with other substance use disorders in an American Indian community sample.
abstract: BACKGROUND
  Alcohol and other substance use disorders (SUD) pose major problems of morbidity and mortality in some American Indian communities, but little is known about the clinical characteristics, risk factors, and consequences of combined alcohol and other substance use disorders (multi-substance use disorder, MSUD) in those communities.
  
  
  METHODS
  Using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), in a community sample of 876 American Indians, the clinical characteristics of lifetime DSM-5 moderate or severe alcohol use disorder alone (AUD alone) (n=146) and MSUD (defined as alcohol and ≥1 other SUD) (n=284) were evaluated and compared to 347 participants with no lifetime SUD (no SUD).
  
  
  RESULTS
  The majority (57%) of participants with a SUD had multi-substance use disorder and 94% of those were with AUD. Stimulants (cocaine and/or amphetamine) and/or cannabis were the most common other SUDs. Participants with AUD alone were more likely to be male and have an earlier age of first alcohol intoxication than those with no SUD. Those with MSUD were more likely to have dropped out of high school, have antisocial personality disorder (ASPD) or conduct disorder (CD), have earlier ages of first alcohol intoxication and first use of cannabis and stimulants, an earlier age of onset of AUD, and more of several AUD symptoms than those with AUD alone, but the same temporal course and time to remission of AUD.
  
  
  CONCLUSIONS
  MSUD is prevalent in this sample, is associated with multiple comorbidities and denotes a more severe alcohol syndrome than AUD alone.
authors.affiliation: Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Gilder
authors.affiliation: Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Stouffer
authors.affiliation: Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Lau
authors.affiliation: Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA. Electronic address: cindye@scripps.edu.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Ehlers
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000235:genetics / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
keywords: Alcohol; American Indian; Clinical course of alcoholism; Multiple substance use disorder