Adult Substance Use Research Articles

Childhood trauma and post-trauma environment affect fear memory and alcohol use differently in male and female mice

BackgroundChildhood trauma is associated with the development of adult mental health and substance use disorders, with females generally being more at risk. Alcohol is commonly used for coping with trauma, and alcohol use disorder (AUD) affects ∼14.4 million adult Americans annually. Research investigating sex differences in the environmental modification of anxiety and alcohol use following childhood trauma will extend our understanding of the etiology of AUD. Here, we sought to model the interacting effects of a single-episode late childhood trauma with post-trauma environment on adult alcohol use using male and female mice. MethodsC57Bl6/J mice (d22) exposed to predator odor (TMT) or water were reared in standard environments (SE) or environmental enrichment (EE). Mice were assessed for adolescent anxiety and conditioned fear, and for adult alcohol use in a limited access, response non-contingent, alcohol exposure paradigm. ResultsA single exposure to predator odor was an effective stressor, inducing long-term sex-dependent changes in conditioned fear and alcohol behaviors that interacted with post-trauma environment. Adolescent EE females showed more conditioned freezing to the trauma-associated context. Adult EE mice consumed less total alcohol than SE mice. However, alcohol use across time differed for males and females. Exposure to a childhood stressor increased alcohol use significantly in females, but not males. EE males, but not EE females, drank less than SE counterparts. ConclusionsFindings from this model recapitulate greater vulnerability to childhood trauma in females and support sex differences in post-trauma development of conditioned fear and alcohol use that are modified by environment.

Exploring the role of emotional and behavioral problems in a personality-targeted prevention program for substance use in adolescents and young adults with intellectual disability

BackgroundAdolescents and young adults with a mild intellectual disability or borderline intellectual functioning (MID-BIF) are at risk for problematic substance use and are more likely to have emotional and behavioral problems than peers without MID-BIF. A personality-targeted prevention program called Take it Personal! effectively reduces substance use in adolescents and young adults with MID-BIF. AimsThe program’s effectiveness was examined on its secondary goal: reducing emotional and behavioral problems. The potentially moderating role of these problems on the program’s effectiveness with substance use was also explored. Methods and proceduresSubstance use and emotional and behavioral problems were compared between participants in Take it Personal! (n = 34) and those in the control condition (n = 32) in a quasi-experimental pre-posttest study with a three-month follow-up. Effectiveness and moderation were assessed with multilevel models. Outcomes and resultsTake it Personal! seems to reduce rule breaking. There were no significant effects on anxiety, withdrawal, and aggression. None of the problem domains moderated the program’s effectiveness on substance use frequency. Conclusions and implicationsTake it Personal! may effectively reduce rule breaking. Moreover, adolescent and young adults with different levels of emotional and behavioral problems benefit equally in terms of reduced substance use.

Longitudinal associations between team sport participation and substance use in adolescents and young adults

BackgroundTeam sport participation contributes to positive outcomes, including increased physical activity, better mental health, and enhanced social engagement. However, longitudinal studies show that team sport participation during adolescence is also associated with unhealthy lifestyle habits, including harmful substance use behaviors. Our objectives were to examine these associations in an adolescent sample, assess differences between sexes, examine the association by sport type, and investigate whether associations carry into young adulthood. MethodOver five years of high school participants reported team sport participation, smoking status, and frequency of alcohol use, three years post-high school participants reported the same behaviors as well as marijuana use. ResultsRegression analyses accounting for individual clustering revealed that participation in team sport during high school was associated with an increased likelihood of current smoking in males and more frequent drinking in both sexes during adolescence. These relationships were strongest in individuals who participated in football. Further analyses revealed that team sport participation in high school was associated with an increased likelihood of more frequent binge drinking in young adulthood; however, team sport participation in young adulthood was associated with a decrease in the likelihood of cigarette smoking and marijuana use in young adulthood. ConclusionOverall, results confirm that team sport participation in adolescence is positively associated with substance use in adolescence, and this association differs by sex. However, team sport participation in young adulthood is negatively associated with harmful substance use. Further research is needed to understand if these trends generalize beyond White adolescents and young adults.

Social Environment and Mental and Behavioral Health Outcomes in Older Adults: A Critical Review

Social environments are complex and critical to older adults’ health. Older adults are vulnerable to lack of social connectedness, social engagement and social contribution. 10-43% of community-dwelling older adults suffer from social isolation and loneliness in the United States. Despite the growing evidence on the impact of social environment on older adults’ health, it remains that the information about older adults’ social environment and its relationships to mental/behavioral health is fragmented. The purpose of this study is to determine the state of the science on social environment components (social connectedness, social engagement, social contribution) and mental/behavioral health (depressive symptoms, anxiety, psychological well-being, substance use, mental healthcare utilization) among community-dwelling older adults (65+ years). Five databases - CINAHL, PubMed, PsycINFO, PsycARTICLES, SocINDEX - were systematically searched using PRISMA guidelines to identify relevant articles from 1990 to 2019. Eleven articles are included in this review, illustrating relationships between social environment and mental/behavioral health. The studies found that poor social connectedness, social engagement, and social contribution were significantly associated with older age, poor perceived health, depression and anxiety symptoms, poor psychological well-being, hopelessness, having multiple chronic conditions, and functional limitations. Low social connectedness was significantly related to poor utilization of mental health services. No significant association was found between social environment and substance use in older adults. The findings of this review add to the literature related to social environment being relevant to older adults’ mental/behavioral health and highlight the need to further our understanding of their dynamic relationships and changes over time.

Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study.

BackgroundLegal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up.Materials and methodsNationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001–2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates.ResultsAmong the diverse sample of 11,996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk.ConclusionsWe do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.

Assessment and treatment of substance use in adults with ADHD: a psychological approach.

Over half of young people and adults diagnosed with Attention Deficit Hyperactivity Disorder [ADHD] also have substance use disorder [SUD]. Their use of substances may arise from an attempt to self-medicate and/or to cope with their difficulties. This manuscript reviews key research in the literature and identifies that traditional SUD psychological interventions are an effective treatment for those presenting with a dual diagnosis of ADHD and SUD. However, typically, this is only available to those presenting to specialist SUD services for treatment of harmful use and/or dependency. This misses an opportunity to intervene much earlier, before drug use escalates to these levels. The manuscript aims to provide practical guidance for healthcare practitioners, by detailing a psychological framework for earlier assessment and intervention of problematic drug use in young people and adults with ADHD. Specific techniques are outlined drawing on psychoeducation, motivational interviewing and cognitive behavioural therapy in a phased approach to address factors that motivate initial use of substances and those that maintain use.

Risks versus consequences of adolescent and young adult substance use: A focus on executive control.

This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD). As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use. Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

ABSTRACT Background Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment. Objectives To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males. Methods Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome. Results One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females’ cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males’ separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes. Conclusion ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.

Profiles of lifetime substance use are differentiated by substance of choice, affective motivations for use, and childhood maltreatment

To develop personalized interventions and improve outcomes in substance-using populations, research is needed on the heterogeneity in substance use patterns and motivations that exists among adult substance users. This study took a person-centered approach to identify profiles of lifetime substance use and discern the psychosocial differences among them. To survey a spectrum of drug use severity, 1106 adults (43.4% women) were recruited from forensic and community samples. Participants reported on the frequency of lifetime substance use across multiple drug categories (sedatives, stimulants, marijuana, heroin, hallucinogens, misuse of prescription drugs) and alcohol use. Latent profile analysis was used to identify distinct profiles of substance use that were then compared on potential risk and maintenance factors for substance use. Four profiles of lifetime substance use emerged that diverged on severity of use and degree of mono vs. polysubstance use (Recreational Marijuana Use, Heavy Multidrug Intoxication, Heavy Marijuana Use, and Heavy Opioid and Polysubstance Use). The profiles differed on affective motivations for substance use (e.g., using to cope vs. using to seek a thrill), age of use onset, drug-related functional impairment, and experiences of childhood maltreatment. Cognitive functioning did not differentiate the heavy substance use profiles. Results provide compelling initial evidence that lifetime patterns of use can be used to identify groups of substance users with distinct risk and maintenance factors. Results highlight affective motivations for substance use and maltreatment history as potential treatment targets and underscore the importance of studying polysubstance use in the context of the opioid epidemic.

Differences in substance use by sexual orientation and gender among Jewish young adults in Israel

BackgroundThis study focuses on sexual orientation and gender-based differences among Israeli young adult substance use behaviors. In addition, it evaluates young adult perception of substance use and acceptance of substances use by close friends.MethodsWe conducted a cross-sectional study. A self-reported anonymous questionnaire was distributed to a convenience sample of 496 young-adults (age: M = 23.14, SD = 2.48), which included 126 heterosexual males, 128 heterosexual females, 131 gay men, and 111 lesbians.ResultsThis study revealed significant sexual orientation and gender differences in all outcomes examined. Significant substance usage differences were found for same-sex orientation as 52% reported cannabis use and 24% reported using other illegal substances during the past 12 months compared to 34 and 6% (respectively) among heterosexuals. Significant gender differences were found, as male participants reported 50% cannabis use and 19% reported other illegal substance use in the past 12 months compared to 35 and 11% (respectively) among females.Additionally, compared with heterosexuals, gay men and lesbians perceived/assessed significantly higher substance usage rates among their close friends and higher levels of substance use acceptance by close friends. Regression models indicated the important role of respondent perceived and acceptance of substance use among close friends.Binge drinking, cannabis use, and other illegal substance use were positively associated with participants’ perceived substance use and substance use acceptance level by close friends, after controlling for gender, sexual orientation, age, and level of education.ConclusionsClose friends and community norms can play an important role in shaping substance usage among young adults, especially among gay men and lesbians. The results of the current study highlight the need for developing prevention and harm reduction drug policies for Israeli young adults, especially for gay men and lesbians. Interventions should also focus on young adult peers and community norms related to substance use by professionals in educational, policy-making, and therapeutic contexts.

Prescribing Trends in Adult ADHD and Co-occurring Substance Use Disorders

Illicit substance use overlapping with mental illness has always been a huge clinical concern. The same extends true for ADHD and substance use overlap as both these conditions alone and together can negatively affect the individual’s quality of life. It is important to understand and identify any potential gaps in-regards to the need vs receiving the treatment for these co-occurring disorders. The data was collected from Board certified, USA based adult psychiatrist. No recent data available that studies the prescribing trends among physicians who treat adult ADHD and substance use disorders. It is important to consider risk factors that may lead for ADHD individuals to use more substances. An important clinical concern is ADHD and substance use overlap decreases the life span by increasing mortality. It is crucial to treat both these conditions by using evidence-based practice norms. We highlight the factors that lead to clinical decision making while treating adult ADHD and co-occurring substance use disorders. Treating these individuals is often times challenging; many times, they are facing challenges in several domains of their lives such as homelessness, no medical care, financial constraints, no social support, unplanned pregnancies, and domestic violence/staying in an abusive relationship, to name a few.

Removing the stigma of medication for opioid use disorder

Removing the stigma of medication for opioid use disorder

Onset Age of Substance Use and Neuropsychological Performance in Hospital Patients.

ObjectiveSeveral studies have found neurocognitive deficits in adolescents following substance abuse. Predisposing risk factors may further impact vulnerability to neurocognitive deficits. Little is known about the cognitive performance of adult onset substance users compared to earlier onset users. This study aims to explore differences in neuropsychological functioning between early (EOAs) and late onset substance abusers (LOAs) when the effects of confounding factors are controlled.MethodData for this cross-sectional study was collected from hospital patients. A total of 164 patients with substance use disorder (SUD) aged 19 to 65, 76 with single-drug diagnosis and 88 with multidrug diagnosis, underwent neuropsychological tests for verbal capacity, attention, speed of processing, perceptual reasoning, memory and learning, executive functioning, and inhibitory capacity. Associations between regular onset age and neuropsychological measures were analysed using in multi-way ANCOVA, and the effect of age, multiple substance abuse, education level and learning difficulties were controlled.ResultsCompared with LOAs, EOAs had weaker performance in the Digit Symbol test for mono-substance users. Meanwhile, compared with EOAs, LOAs had weaker performance in the Delayed Visual Memory test and the Raven test for mono-substance users, and the Block Design test for poly-substance users. From the confounding factors, early onset age of substance use is heightened among individuals with learning disabilities.ConclusionsOnset age of substance use is related to the deterioration of performance in neuropsychological tests. Premorbid poor learning and inhibitory capacity may be important predisposing risk factors of SUD. Conversely, high level of education may be a protective factor for cognitive performance in patients with SUD.

Take it personal! Development and modelling study of an indicated prevention programme for substance use in adolescents and young adults with mild intellectual disabilities and borderline intellectual functioning.

BackgroundThis paper describes the theory and development of Take it personal! an indicated prevention programme aimed at reducing substance use in individuals with mild intellectual disabilities and borderline intellectual functioning.MethodThe process of the development of Take it personal! followed the steps of the Intervention Mapping protocol. Take it personal! is based on the theory that personality traits are an important construct to understand substance use (14–30 years old). A small modelling study was conducted with six adolescents to examine the feasibility, user‐friendliness and potential effectiveness of the intervention.ResultsThe results showed that the intervention has good feasibility and user‐friendliness. Post‐intervention evaluation of frequency, binge drinking and problematic use indicated that use was lower than at pre‐intervention.ConclusionsTake it Personal! can be a promising preventive intervention designed to reduce substance use in individuals in this target group. A larger scale study is needed to draw further conclusions.

Adult Family Adversities and Bullying among Urban African American Adolescents

ABSTRACT The current study examined how adverse family events (i.e., adult family incarceration, adult family substance use, and adult family mental illness) were associated with adolescent bullying perpetration. More specifically, this study examined whether levels of future orientation mediated the link between adult family incarceration, substance use, and mental illness and bullying perpetration. A sample of 637 African American adolescents from the Southside of Chicago was used for this study. Adult family incarceration, substance use, and mental illness were all found to be positively associated with bullying perpetration. Also, adult family substance use and mental illness were positively associated with low levels of future orientation, which was significantly related to bullying perpetration. These findings demonstrate the importance of understanding how adverse family events are related to adolescent bullying. Implications for future research are discussed.

Test-retest reliability of DSM-5 substance disorder measures as assessed with the PRISM-5, a clinician-administered diagnostic interview

AimIn DSM-5, the definitions of substance use disorders (SUD) were changed considerably, yet little is known about the reliability of DSM-5 SUD and its new features. MethodsThe test-retest reliability of DSM-5 SUD and DSM-IV substance dependence (SD) was evaluated in 565 adult substance users, each interviewed twice by different clinician interviewers using the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). DSM-5 SUD and DSM-IV SD criteria were assessed for past year and lifetime, yielding diagnoses and severity levels for alcohol, tobacco, cannabis, cocaine, heroin, opioids, sedatives, hallucinogen, and stimulant use disorders. Cohen’s and intraclass correlation coefficients (ICC) assessed reliability for categorical and graded outcomes, respectively. Factors potentially influencing reliability were explored, including inpatient vs. community participant, days between interviews gender, age, race/ethnicity, and SUD severity. ResultsDSM-5 SUD diagnoses had substantial to excellent reliability for most substances (κ = 0.63−0.94), and moderate for others (hallucinogens, stimulants, sedatives; κ = 0.50−0.59). For graded outcomes (DSM-5 SUD mild, moderate, severe; criteria count 0–11), reliability was substantial to excellent (ICC = 0.74−0.99). Comparisons of DSM-5 SUD and DSM-IV SD reliability showed few significant differences. Reliability of the DSM-5 craving criterion was excellent for heroin (κ = 0.84−0.95) and moderate to substantial for other substances (κ = 0.49−0.76). The only factor influencing reliability of SUD was severity, with milder disorders significantly more likely to be discordant between the interviews. ConclusionReproducibility is crucial to good measurement. In a large sample using rigorous methodology, diagnoses and dimensional measures from clinician-administered interviews for DSM-5 SUD were generally highly reliable.

Child Maltreatment, Early Adult Substance Use, and Mediation by Adolescent Behavior Problems.

The purpose of the current study was to examine the potential mediating effects of internalizing and externalizing problems at ages 14, 16 and 18 between types of childhood maltreatment and alcohol and marijuana use problems and disorders in young adulthood. Data were from 473 young adults who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Path analysis was conducted to examine pathways between maltreatment type (birth through age 12), internalizing and externalizing problems at three time points during adolescence, and alcohol and marijuana problem use in young adulthood. Findings indicated significant pathways between physical abuse and internalizing problems at 14, which was associated with alcohol-related substance use disorder in adulthood. Externalizing problems and internalizing problems at age 14 mediated the relationship between physical abuse and marijuana-related symptoms in young adulthood. Emotional and sexual abuse were not associated with substance use problems. Implications for practice are discussed.

Homicide-suicide across the lifespan: a mixed methods examination of factors contributing to older adult perpetration

Objectives The purpose of this study is to determine how individual and contextual factors that contribute to homicide-suicide (HS) differ between young adults, middle-aged adults, and older adults, and to describe, in detail, the circumstances that lead to HS by older adults. Methods Data were obtained from the Center for Disease Control and Prevention (CDC) National Violent Death Reporting System. We used a sequential mixed methods approach to the analysis. Guided by the Marzuk HS framework, we conducted quantitative analyses to identify characteristics distinguishing older adult HS perpetrators from younger HS perpetrators. These results guided the qualitative content analysis, which further described the circumstances surrounding HS incidents perpetrated by older adults. Results While HS perpetrated by young and middle-aged adults were quite similar, the demographic characteristics, victim-perpetrator relationship, and contributing factors in HS incidents perpetrated by older adults were substantially different. Mental health and depressed mood were more common among older adult perpetrators, and jealousy, fights, and substance use issues were less common, relative to younger perpetrators. Escalating intimate partner violence and caregiving/health-related issues, including caregiving strain, housing transitions, and financial problems, were the primary contributors to older adult HS. Conclusion HS perpetrated by older adults was both similar and different from incidents perpetrated by younger adults. Programs that prevent or de-escalate intimate partner violence would likely prevent many HS incidents perpetrated by older adults, but health and aging-related issues must also be considered.

Food Insecurity, Sexual Risk, and Substance Use in Young Adults

PurposeThe aim of the study was to determine the association between food insecurity, sexual risk behaviors, sexually transmitted infections (STIs), and substance use in a nationally representative sample of U.S. young adults. MethodsCross-sectional nationally representative data of U.S. young adults aged 24–32 years from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed. Multiple logistic and linear regression analyses were conducted with food insecurity as the independent variable and self-reported STIs, sexual risk behaviors, and substance use as the dependent variables, adjusting for covariates and stratifying by sex. ResultsOf the 14,786 young adults in the sample, 14% of young women and 9% of young men were food insecure. Food-insecure young women had greater odds of any STI, HIV, chlamydia, exchanging sex for money, and multiple concurrent sex partners in the past 12 months compared to young women reporting food security, adjusting for covariates. Food insecurity was associated with higher odds of any STI, chlamydia, and exchanging sex for money among young men who identify as gay or bisexual, but not in the general population of young men. Food insecurity was associated with greater odds of marijuana use, methamphetamine use, and nonmedical use of prescription opioids, sedatives, and stimulants in both young men and women. ConclusionsFood insecurity is associated with risk behaviors and self-reported STIs, including HIV, in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate.

Different factors predict adolescent substance use versus adult substance abuse: Lessons from a social-developmental approach.

This 17-year prospective study applied a social-developmental lens to the challenge of distinguishing predictors of adolescent-era substance use from predictors of longer term adult substance use problems. A diverse community sample of 168 individuals was repeatedly assessed from age 13 to age 30 using test, self-, parent-, and peer-report methods. As hypothesized, substance use within adolescence was linked to a range of likely transient social and developmental factors that are particularly salient during the adolescent era, including popularity with peers, peer substance use, parent-adolescent conflict, and broader patterns of deviant behavior. Substance abuse problems at ages 27-30 were best predicted, even after accounting for levels of substance use in adolescence, by adolescent-era markers of underlying deficits, including lack of social skills and poor self-concept. The factors that best predicted levels of adolescent-era substance use were not generally predictive of adult substance abuse problems in multivariate models (either with or without accounting for baseline levels of use). Results are interpreted as suggesting that recognizing the developmental nature of adolescent-era substance use may be crucial to distinguishing factors that predict socially driven and/or relatively transient use during adolescence from factors that predict long-term problems with substance abuse that extend well into adulthood.