Summary: The majority of 18 year-olds with substance abuse disorder who were followed as part of a longitudinal study for 32 years still had symptoms of SUD during adulthood.
Source: University of Michigan
While it’s estimated that 1 in 3 Americans will develop a substance use disorder in their lifetime, experts know little about the long-term outcomes for people with substance use disorder symptoms from adolescence through adulthood.
New University of Michigan research findings on the topic are grim: The majority of 18-year-olds with severe substance use disorder symptoms who were followed in a longitudinal study over 32 years still had multiple substance use disorder symptoms as adults, according to a new study from the U-M School of Nursing.
The study, appearing in JAMA Network Open, found:
- An estimated 12% of 18-year-olds had severe substance use disorder, or SUD, symptoms.
- U.S. adolescents with severe SUD symptoms were significantly more likely to report prescription drug misuse in adulthood.
- The relationship between severe SUD symptoms and later SUD symptoms also held for adolescents with severe alcohol, cannabis and other drug use disorder symptoms.
- Most adults in the study prescribed opioids, benzodiazepines or other sedatives/tranquilizers had multiple SUD symptoms during adolescence.
“This is a major wake-up call,” said lead author Sean Esteban McCabe, professor at the U-M School of Nursing and director of the Center for the Study of Drugs, Alcohol, Smoking, and Health.
“The majority of middle-age adults being prescribed these medications had multiple substance use disorder symptoms at age 18, raising serious concerns about the safety of prescribing controlled substances to these individuals.
“Some of the disorders and conditions we treat with these same medications are also associated with an increased risk for substance use disorder, such as anxiety disorders, sleep disorders and pain.
“We must rethink how we screen and prescribe to individuals who have multiple substance use disorder symptoms in their past, because they might need additional help to take their medication safely. For example, some people in long-term recovery from substance use disorders use ‘gatekeepers’ to help dispense and dispose of medications, and lockboxes to reduce access to only the gatekeepers.”
Most of the people in the study did not seek treatment, and the findings suggest the need to find ways of offering treatment over long periods of time even if the person isn’t ready for help, McCabe said. Better screening, prevention and education through adulthood would also help.
“Screening that accounts for polysubstance use and substance use disorder symptom severity during adolescence can identify individuals at the greatest risk for prescription drug misuse and substance use disorder in adulthood,” McCabe said.
Additionally, insurers can assist by helping cover the time it takes for wraparound services, and counties and states can use the opioid settlement funds to invest in evidence-based prevention and treatment efforts, he said.
McCabe and colleagues sought to understand the association between an adolescent’s substance use disorder symptom severity and later medical use of prescription drugs, prescription drug misuse and substance use disorder symptoms at ages 35-50.
Eleven cohorts of 12th graders were followed from age 18 to age 50 in the Monitoring the Future study, one of the nation’s most relied upon sources of information on emerging trends in illicit drug, alcohol and tobacco use among American adolescents, college students and young and middle-aged adults.
Subsequent studies will examine the role of stimulant and nonstimulant medication to treat ADHD and the later misuse of stimulants and other drugs.
Funding: The current study is funded by the National Institute on Drug Abuse, part of the National Institutes of Health.
Co-authors include John Schulenberg, Philip Veliz and Vita McCabe of U-M, and Ty Schepis of Texas State University. All are members of U-M’s Center for the Study of Drugs, Alcohol, Smoking, and Health.
About this substance use disorder research news
Author: Laura Bailey
Source: University of Michigan
Contact: Laura Bailey – University of Michigan
Image: The image is in the public domain
Original Research: Open access.
“Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood” by Sean Esteban McCabe et al. JAMA Network Open
Abstract
Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood
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.
