Substance Use Frequency and Psychotic-Like Experiences Within a Broader Psychosocial Network

Abstract Substance use is associated with psychotic-like experiences (PLEs), but it remains unclear how these associations vary with frequency of use and broader psychosocial difficulties. We examined alcohol, cannabis, and stimulant use in relation to PLEs within a broader psychosocial network and compared patterns across substance use frequency groups. Data from 1196 adults were analyzed using regularized network estimation, bridge centrality, shortest path analyses, network comparison tests, and exploratory parallel indirect association models. Networks included alcohol, cannabis, and stimulant use frequency, impulsivity, other psychopathological symptoms, recent stress exposure, adverse childhood experiences, delusion-like experiences, and auditory perceptual abnormalities. Participants were classified as nonusers, lower frequency users, or higher frequency users using an exploratory data-derived frequency boundary. Higher frequency users showed greater psychosocial/PLE network connectivity than nonusers, while the full lower and higher frequency networks differed in both global strength and overall structure. Delusion-like experiences showed more consistent direct network associations with substance use frequency than auditory perceptual abnormalities. In the full network, delusion-like experiences and other psychopathological symptoms showed the highest bridge strength. Exploratory indirect association models indicated different patterns across frequency groups: among lower frequency users, supported total substance–PLE associations were limited to stimulant use and involved impulsivity, other psychopathological symptoms, and adverse childhood experiences; among higher frequency users, supported substance–delusion-like experience associations more consistently involved other psychopathological symptoms and recent stress exposure. Higher frequency substance use was associated with a more strongly interconnected psychosocial/PLE network and with more consistent associations with delusion-like experiences. Frequent substance use may therefore mark a broader mental health burden rather than an isolated behavioral exposure. Given the cross-sectional design, these findings should not be interpreted causally or as evidence of temporal mediation.