Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood
Open accessAbstract
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.
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Most adolescents with severe SUD symptoms do not age out of symptomatic use over a 32-year period.
“Further, most adolescents with severe SUD symptoms do not age out of symptomatic use over a 32-year period (McCabe et al., 2022).”
From The substance use disorder treatment gap among US college students: Findings from the 2021 National Survey on Drug Use and Health (2024) · cites this paper as McCabe et al., 2022
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“The use of these drugs have been found to interfere with healthy brain development, among youths who abuse drugs early and frequently also face a higher risk of developing a drug abuse disorder in adulthood (McCabe et al., 2022; Winters & Arria, 2011).”
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“…substance use disorder (SUD) in young people is diverse in its prevalence, onset, and course, though there is consensus that use in this sensitive developmental period is associated with increased burden of disease (Degenhardt et al., 2016) and adverse long-term outcomes (McCabe et al., 2022).”
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Substance Misuse in Young People
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“…characterized by compulsive use that leads to clinically significant impairment and disruptions to daily life (American Psychiatric Association, 2013) and is associated with adverse health and psychosocial outcomes that can persist through adulthood (McCabe et al., 2022; Newcomb and Locke, 2005).”
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“…demonstrate that youth with substance-related concerns present an elevated risk for subsequently developing a substance use disorder in adulthood (McCabe et al., 2022); these youth also have high comorbidity with a range of internalizing and externalizing mental health concerns (Hemphälä &…”
Multiple Substance Use Disorders From Adolescence to Midlife
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Trajectories of metal music engagement during adolescence and substance use in adulthood
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“63 The most commonly reported substances used by youths were alcohol, followed by cannabis and nicotine.”
Solberg, M. A., Veliz, P. T., Jardine, J., Pang, Y. C., McCabe, S. E., Evans‐Polce, R. J., & Patrick, M. E. (2026) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2026.100732
“Habits formed during this period shape long-term health, and persistent substance use can undermine later outcomes (Lawrence et al., 2017; McCabe, Schulenberg, et al., 2022; Nelson et al., 2015; Patrick et al., 2020, 2023, Patrick, Peterson, et al., 2024; Scales et al., 2016).”
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“…with non-prescribed opioid use, suggesting that early high-use trajectories could indicate vulnerability to a broader range of later drug-related consequences rather than to opioid use alone (Cicero et al., 2020; Compton et al., 2019; Crummy et al., 2020; McCabe et al., 2022c, 2019b, 2019a).”
Roura, M. T., & Mauro, P. M. (2026) · JMIR Formative Research · doi:10.2196/100667
“Substance use also peaks in young adulthood, making them a high-risk group for substance use–related harms [3].”
Childhood loneliness and deficit-accumulation frailty progression in mid-to-late life
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- Authors
- McCabe, S. E., Schulenberg, J. E., Schepis, T. S., McCabe, V. V., & Veliz, P. T.
- Affiliations
- University of Michigan (US)
- Texas State University (US)
- Corresponding author
- McCabe, Sean Esteban
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2022-04-01
- Volume
- 5
- Issue
- 4
- Pages
- e225324
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC8976240
- OpenAlex
- W4224242436
- Cited by
- 79
- References
- 48
- Citations by year
- 2026: 18 · 2025: 18 · 2024: 21 · 2023: 14 · 2022: 8
- FWCI
- 11.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute on Drug Abuse (R01DA042146, R01DA036541, R01DA031160, R01DA016575, R01DA001411, R01DA043691)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Demography › Youth, Drugs, and Violence
- Keywords
- substance use disorders, prescription drug misuse, opioid use, alcoholism, cannabis use disorder, long-term outcomes, adulthood, longitudinal cohort, adults, age 50, attrition
- MeSH terms
- Adolescent, Adult, Analgesics, Opioid, Female, Humans, Hypnotics and Sedatives, Male, Middle Aged, Substance-Related Disorders, Prescription Drugs, Prescription Drug Misuse
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