Modeling the Associations Between Personality, Cognition, and Social Determinants in Relation to Substance Use Disorder Severity in Community Adults.

OBJECTIVE: To develop more effective intervention strategies for substance use disorder (SUD), it is essential to create models that evaluate the relative influence of various risk factors. This study constructed an integrated biopsychosocial model to examine the associations of different risk vulnerability domains with SUD severity. METHOD: 251 community adults aged 18-55 (female = 48.2%; White = 64.1%, Black = 26.7%, Asian American = 8.0%, American Indian/Alaska Native = 2.0%, Native Hawaiian/Pacific Islander = 1.6%, Hispanic =7.6%), completed clinical diagnostic interviews, neuropsychological testing, behavioral tasks, and surveys to assess SUD severity and an array of risk factors. We created latent variables to represent Disordered Personality, Cognitive Ability, and Social Determinant domains expected to contribute to SUD severity. We used structural equation modeling to model the cross-sectional associations of SUD severity with the latent variables (Disordered Personality, Cognitive Ability, and Social Determinant) and Delay Discounting. RESULTS: An integrated model showed that Social Determinants (β = 0.77, z-test = 6.06, p < 0.001; 95% CI [0.72, 0.82]), Disordered Personality (β = 0.17, z-test = 2.23, p = 0.026; 95% CI [0.05, 0.29]) and Delay Discounting (β = 0.16, z-test = 3.13, p = 0.002; 95% CI [0.04, 0.28]) explained variance in SUD severity. In contrast, Cognitive Ability was not associated with SUD severity in the integrated model (β = 0.18, z-test = 1.56, p > 0.05). CONCLUSIONS: These cross-sectional findings support biopsychosocial models of SUD and underscore the role of social determinant risk factors in understanding SUD severity. Further research is needed to refine these models for improved assessment and treatment strategies.