Latent classes of lifetime drug use disorder in national epidemiological survey on alcohol and related conditions – III

•LCA of NESARC-III to analyze co-occurrence of lifetime SUDs and DSM-5 diagnoses.•Main result: four classes; very low risk (97.19%); opioid and sedative (1.11%); stimulant, cocaine and marijuana (1.28%); and high multimorbidity (0.42%).•The three higher risk classes were also associated with higher risk of lifetime personality disorder and mood disorders; the opioid and sedative class was associated with higher odds of lifetime eating disorder. People diagnosed with multiple drug use disorders are high-risk subpopulations, but changes in diagnostic classification and drug use prevalence mean patterning of drug use disorders has changed in the past decade. We analyzed comorbidity patterns of lifetime drug use disorder in a general population sample. Using latent class analysis, we derived lifetime drug use disorder classes based on dichotomous indicators of sedative, cannabis, opioid, cocaine, stimulant, hallucinogen, inhalant/solvent, club drug, heroin, and other drug use disorders in the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309). Multinomial models assessed associations between sociodemographic and clinical correlates and latent class status. Four latent classes of lifetime substance use disorder were identified: A very low risk class, a class with high opioid, sedative and heroin comorbidity, a class based on cocaine and stimulant comorbidity, and class with high likelihood of multiple lifetime drug use disorders. All higher risk classes were associated with higher risk of lifetime personality disorder and mood disorder. Conduct disorder was also associated with higher risk, but level of risk varied by class. Opioid and sedative class was associated with higher odds of lifetime eating disorder diagnosis. Comorbidity of drug use disorders is associated with a range of lifetime mental health disorder diagnoses. Unlike previous research, we did not identify a cannabis use class, possibly due to changes in diagnostic criteria and cannabis prevalence rates.