Incidence of substance use disorders and comorbidities in the All of Us Research Program

Document Type

Article

Publication Date

7-1-2026

Publication Title

Drug and alcohol dependence

Keywords

Humans, Female, Substance-Related Disorders, Comorbidity, United States, Male, Incidence, Middle Aged, Adult, Mental Disorders, Cohort Studies, Electronic Health Records, Aged

Abstract

BACKGROUND: Substance use disorders (SUDs) are highly associated with other mental health conditions and disparities exist across sociodemographic characteristics. We aimed to estimate the incidence of specific SUDs and comorbidities with United States electronic health record data.

METHODS: We harnessed data from the All of Us Research Program cohort from Jan 1, 2017 to Jun 30, 2022 (N = 266,472). We identified newly documented SUDs after a two-year washout period, along with related mental health diagnoses. Multivariate logistic regression models estimated associations between incident SUDs and comorbidities.

RESULTS: Participants included 160,792 females (60.3%) aged 51.6 years on average [SD= 16.7]. The incidence of any SUD was 4.8%; among these, 74.4% had at least one mental health comorbidity. Alcohol (1.6%) and cannabis use (1.6%) disorders were the most common. Individuals with newly documented SUDs (vs. non-SUD) were more often male, Black, socioeconomically disadvantaged, and unmarried (all p <  0.001). Overall, anxiety (25.3%) and depression (23.1%) were the most frequent comorbidities, though the prevalence of comorbid mental health conditions ranged from 48% to 77% across SUD subtypes. Most other mental health conditions were associated with elevated odds of newly documented SUDs (AOR range=4.6-9.7, p <  0.001), particularly for stimulant, cocaine, and opioid use disorders.

CONCLUSIONS: Newly documented SUDs in this diverse cohort frequently co-occurred with other mental health conditions, with diagnostic patterns varying across sociodemographic groups. Findings underscore the importance of integrated behavioral health screening and interventions that account for comorbidity. These patterns further highlight the need for strategies that enhance equitable access to prevention and treatment for individuals with SUDs.

Medical Subject Headings

Humans; Female; Substance-Related Disorders; Comorbidity; United States; Male; Incidence; Middle Aged; Adult; Mental Disorders; Cohort Studies; Electronic Health Records; Aged

PubMed ID

42068725

Volume

284

First Page

113175

Last Page

113175

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