Substance use in adolescence often continues in adulthood, study finds

Adolescents who reported multiple symptoms of severe substance use disorder were more likely to report these symptoms in adulthood, according to findings published in JAMA Network Open.

These adolescents were also more likely to self-treat with opioids, sedatives or tranquilizers in adulthood, Sean Esteban McCabe, PhD, the director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan, and colleagues reported.

“Teens with substance use disorder will not necessarily mature out of their disorders, and it may be harmful to tell those with severe symptoms that they will,” McCabe said in a press release. “Our study shows us that severity matters when it comes to predicting risk decades later, and it’s crucial to educate and ensure that our messaging to teens with the most severe forms of substance use disorder is one that’s realistic. We want to minimize shame and sense of failure for these individuals.”

In the national multicohort Monitoring the Future study, McCabe and colleagues followed 5,317 individuals for more than 30 years. The participants were enrolled while in high school from 1976 to 1986. They completed baseline self-administered surveys in classrooms and follow-up surveys via mail. Among 11 cohorts of high school seniors, 51.2% were women and 77.9% were white. The overall response rate from enrollment at age 18 years to the end of the follow-up period at age 50 years was 53%.

Substance use from adolescence to adulthood

At age 18 years, 20.1% of participants (95% CI, 18.9-21.3) reported two to three substance use disorder (SUD) symptoms, 12.1% (95% CI, 11.1-13) reported four to five symptoms and 11.5% (95% CI, 10.6-12.4) reported six or more symptoms.

Among adolescents with severe SUD symptoms, 61.6% (95% CI, 55.7-66.9) had two or more symptoms in adulthood, according to McCade and colleagues. This association applied to baseline symptoms of alcohol, cannabis and other drug use disorder.

Participants with the highest SUD symptom severity at age 18 years were more likely to report prescription drug use and misuse in adulthood (4 to 5 symptoms: adjusted OR [aOR] = 1.56; 95% CI, 1.06-2.32; six symptoms or more: aOR = 1.55; 95% CI, 1.11-2.16), according to the researchers.

Moreover, about half of adults (52.2%) who reported using prescribed opioids, sedatives or tranquilizers in the past year had multiple SUD symptoms during adolescence. McCade and colleagues reported that prescription drug use and misuse increased in participants aged 35 to 50 years, while SUD symptoms decreased in those aged 45 to 50 years.

“We found clear evidence for long-term associations of moderate to severe levels of SUD symptoms in adolescence with prescription drug use, misuse and SUD symptoms in adulthood,” the researchers wrote. “The findings suggest that screening that accounts for SUD symptom severity can enhance identification of individuals at the greatest risk for later prescription drug misuse and SUD.”

Drug use screening among adolescents “is extremely important for early intervention and prevention of the development of substance use disorder,” Nora Volkow, MD, the director of the National Institute on Drug Abuse (NIDA), said in the press release.

“This is critical, especially as the transition from adolescence to adulthood, when brain development is still in progress, appears to be a period of high risk for drug use initiation,” she said.

Long-term consequences

In a related commentary, Volkow and Eric M. Wargo, PhD, a science writer at NIDA, said the study showed that “teens with SUDs cannot necessarily be expected to age out of their disorders.”

Self-reported symptoms, survivorship bias and the in-school modality of the baseline survey may have led to an underestimation of the magnitude of adolescent SUD, according to the authors.

“The findings about the long-term consequences of adolescent SUD point to the need for screening of SUD in adolescents and for interventions that are graded to its severity, including for mild SUD and for reducing severity in those with moderate or severe SUD,” Volkow and Wargo wrote.

References:

Drug use severity in adolescence affects substance use disorder risk in adulthood. https://www.nih.gov/news-events/news-releases/drug-use-severity-adolescence-affects-substance-use-disorder-risk-adulthood. Published April 1, 2022. Accessed April 1, 2022.

McCabe SE, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.5324.

Volkow ND, Wargo EM. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.5656.