Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood
Abstract
Importance
Although more than 1 in every 3 US individuals will develop a substance use disorder (SUD) in their lifetime, relatively little is known about the long-term sequelae of SUD symptoms from adolescence through adulthood.
Objective
To evaluate the longitudinal associations between adolescents’ SUD symptom severity with later medical use of prescription drugs (ie, opioids, sedatives, and tranquilizers), prescription drug misuse (PDM), and SUD symptoms at ages 35 to 50 years.
Design, Setting, and Participants
Eleven cohorts of US 12th grade students were followed longitudinally from age 18 years (1976-1986) to age 50 years (2008-2018) in the Monitoring the Future (MTF) study. Baseline surveys were self-administered in classrooms, and follow-ups were conducted by mail. Data were analyzed from June 2021 to February 2022.
Exposure
Response to MTF study between 1976 and 2018.
Main Outcomes and Measures
Sociodemographic variables were measured at baseline. All bivariate and multivariate analyses use attrition weights to adjust for attrition by age 50 years within the sample. SUD symptoms, prescription drug use, and PDM were measured at baseline and every follow-up.
Results
The sample of 5317 individuals was 51.2% female (2685 participants; 95% CI, 49.6%-52.6%) and 77.9% White (4222 participants; 95% CI, 77.6%-79.1%). Participants were surveyed beginning at age 18 years and ending at age 50 years. The baseline response rate ranged from 77% to 84%, and the 32-year retention rate was 53%. Most adolescents with most severe SUD symptoms at age 18 years had 2 or more SUD symptoms in adulthood (316 participants [61.6%]; 95% CI, 55.7%-66.9%), and this association held for baseline alcohol, cannabis, and other drug use disorder symptoms. Adolescents with the highest SUD symptom severity at age 18 years had the highest adjusted odds of prescription drug use and PDM in adulthood (4-5 symptoms, adjusted odds ratio, 1.56; 95% CI, 1.06-2.32; ≥6 symptoms, adjusted odds ratio, 1.55; 95% CI, 1.11-2.16). The majority of adults using prescribed opioids, sedatives, or tranquilizers (568 participants [52.2%]; 95% CI, 48.4%-55.9%) in the past year had multiple SUD symptoms at age 18 years.
Conclusions and Relevance
These findings suggest that most adolescents with severe SUD symptoms do not transition out of symptomatic substance use, and the long-term sequelae for adolescents with more severe SUD symptoms are more deleterious than those for adolescents with no or low severity. Prescribers should be aware that many adults prescribed opioids, sedatives, or tranquilizers had multiple SUD symptoms during adolescence and require careful assessment and monitoring.
Research interpretation
In this study researchers followed 5317 people who turned age 18 years between 1976 and 1986 till they turned 50 years in the Monitoring The Future (MTF) study. Baseline surveys were conducted in class rooms and follow up done via mail. Data was analyzed from June 2021 to February 2022.
The researchers tracked the 18 year olds with symptoms of substance use disorder (SUD) to see if they had symptoms at ages 35 to 50 years.
Key findings of the study
At baseline among the 18 year olds,
- Approximately 1 in 5 respondents (20.1%; 95% CI, 18.9%-21.3%) indicated 2 to 3 SUD symptoms.
- 12.1% (697 participants; 95% CI, 11.1%-13.0%) reported 4 to 5 SUD symptoms.
- 11.5% (753 participants; 95% CI, 10.6%-12.4%) reported 6 or more SUD symptoms.
In the follow up it was revealed that,
- Compared to those with no SUD symptoms at baseline those who had two or more symptoms had higher odds of past-year medical prescription drug use and prescription drug misuse (PDM).
- Compared to those with no SUD symptoms at baseline those having one or more SUD symptoms at baseline had higher odds of having two or more SUD symptoms in adulthood
- Those who had severe SUD symptoms at baseline (61.6% with 6 or more symptoms) had atleast 2 SUD symptoms in adulthood. This association applied across alcohol use disorder, cannabis use disorder and other drug use disorder problems.
- Compared to those with no SUD symptoms at baseline those with severe SUD symptoms (4-5 symptoms and 6 or more symptoms) were about one and a half times more likely to have past-year prescription drug use in adulthood.
- Compared to those with no SUD symptoms at 18 years those with severe SUD symptoms (4-5 symptoms and 6 or more symptoms) had two times greater odds of having PDM or two or more SUD symptoms in adulthood.
- The majority of adults prescribed opioids, sedatives, tranquilizers, or at least one of these classes in the past year had two or more SUD symptoms when they were 18 years.
The data show that most of the participants in the study with long-term substance use disorder did not seek treatment.
This is a major wake-up call,” said Sean Esteban McCabe, study co-author and a professor at the University of Michigan School of Nursing in Ann Arbor, as per UPI.
We must rethink how we screen and prescribe to individuals who have multiple substance use disorder symptoms in their past.”
Sean Esteban McCabe, study co-author, professor at the University of Michigan School of Nursing in Ann Arbor
Sources:
JAMA Network: “Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood“
UPI: “Most teens with substance use disorder still have it as adults, study finds“