Problematic behaviors can occur without distress: A person-centered analysis of behavioral, substance-related, and mental health indicators

The recognition of problematic behaviors has underscored the need for conceptual models to explain their complex co-occurrence with both symptoms of mental health and problematic substance use. Following a transdiagnostic approach, Latent Class Analysis (LCA) was utilized to a large sample of the Iranian general population (N = 2971; Mean age = 26.48 ± 7.93; Female% = 71.9 %) to identify latent subgroups of co-occurrence based on endorsement of symptom scales between mental health (e.g., depression, anxiety, stress), behavior (e.g., digital and internet behavior), and substance use indicators (e.g., alcohol use, drug use, smoking). Five latent subgroups were identified, reflecting varying co-occurrence of problematic behaviors and problematic substance use with emotional symptoms. Only gender distinguished between the two classes; other demographics (age, educational attainment, marital status, occupational status, and income level) were not significant after the three-step adjustment. Of the five classes, only one class demonstrated a high level of co-occurrence between problematic behaviors, problematic substance use, and emotional distress. Notably, certain classes characterized by co-occurring problematic behaviors and problematic substance use were present without the emergence of significant mental health symptomatology, suggesting that affective dysregulation might not be a common process across all addictive behaviors. The findings highlight the co-occurrence of addictive behaviors and shed light on the limitations of perspectives that assume distress is necessary for the assessment of problematic behaviors. Consequently, transdiagnostic perspectives should be expanded to consider non-affective mechanisms of dysfunction, which have implications for assessment and intervention planning for co-occurring problematic behaviors and problematic substance use.