Patterns of Substance Use and Associations with Mental, Physical, and Social Functioning

A Latent Class Analysis of a National Sample of U.S. Adults Ages 30–80

Published in: Substance Use & Misuse, Volume 56, Issue 1, pages 131–139 (2021). doi: 10.1080/10826084.2020.1843059

Posted on on February 10, 2021

by Joan S. Tucker, Wenjing Huang, Harold D. Green, Michael S. Pollard

Read More

Access further information on this document at Substance Use & Misuse

This article was published outside of RAND. The full text of the article can be found at the link above.

Trends show increased substance use among adults, yet little research on general population samples has examined differential patterns of licit and illicit substance use that can inform prevention and treatment efforts. This study identifies distinct patterns (classes) of substance use among 30- to 80-year olds, identifies demographic subgroups with the highest probability of class memberships, and compares classes on key indicators of functioning.


Participants (n = 1,877) were from the RAND American Life Panel. Online survey measures included current alcohol, tobacco, cannabis, and nonmedical prescription drug use, as well as mental, physical, and social functioning.


Latent class analysis identified four classes: "Lighter Drinking" (46.6%), "Abstaining" (33.7%), "Heavy Drinking with Cigarette/Cannabis Use" (17.1%), and "Cigarette Smoking with Prescription Drug/Cannabis Use" (2.6%). Of these classes, "Cigarette Smoking with Prescription Drug/Cannabis Use" reported the worst mental and physical functioning, and greater loneliness than the "Lighter Drinking" class. "Heavy Drinking with Cigarette/Cannabis Use" reported worse mental and physical functioning than the "Lighter Drinking" class and less social support than the "Lighter Drinking" and "Abstaining" classes. The "Abstaining" class reported consistently worse functioning than the "Lighter Drinking" class. Both polysubstance use classes were associated with younger age, less education, and lower income, and heavy drinking polysubstance use was associated with being male and unmarried.


Although lighter drinking was the most common pattern, 20% of adults were classified into two polysubstance use classes associated with poorer functioning. Targeted efforts may be needed to reach certain subgroups of adults who are particularly susceptible to polysubstance use.

Research conducted by

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.