Multiple Substance Use Disorders From Adolescence to Midlife.

Authors

Sean Esteban McCabe, Ty S Schepis, Timothy E Wilens, Emily Pasman, Vita V McCabe, Philip T Veliz

Published in

Journal of addiction medicine. Jul 01, 2026. Epub Jul 01, 2026.

Abstract

To assess associations between symptomatic polysubstance use and symptom severity during adolescence and later substance use disorder (SUD) symptoms in midlife.
Multi-cohorts of nationally representative US adolescents in 12th grade (N=12,025; baseline cohort years 1976-2002) were followed longitudinally to age 55 (follow-up years 1993-2019). Poisson regression models were fitted longitudinally, accounting for repeated measures, panel attrition, and covariates.
An estimated 8.9% (95% CI=8.3%-9.5%) of US adolescents had moderate-to-severe SUD symptoms involving multiple substances (ie, 4+ SUD symptoms for 2+ substances). The bivariate and multivariate relationships between SUD symptom severity and multiple SUDs at baseline and subsequent SUD symptoms in midlife (ages 35-55) indicated a positive near-linear association. Over two-thirds of adolescents with moderate-to-severe SUD symptoms involving multiple substances had multiple SUD symptoms in midlife (68.6%, 95% CI=63.0%-73.7%). Most adolescents with moderate-to-severe SUD symptoms of one substance and those with fewer SUD symptoms involving multiple substances (ie, 1-3 SUD symptoms for 2+ substances) persisted with multiple SUD symptoms in midlife (57.2%, 95% CI=53.2%-61.0% and 56.4%, 95% CI=51.4%-61.4%, respectively). Adolescents with moderate-to-severe SUD symptoms involving multiple substances had substantially greater odds of SUD symptoms in midlife relative to asymptomatic adolescents (aRR=2.80, 95% CI=2.49-3.15).
Most US adolescents with symptomatic polysubstance use or moderate-to-severe SUD symptoms persisted with multiple SUD symptoms in midlife. Adolescent symptomatic polysubstance use is associated with a more severe developmental course in midlife than those with the same SUD symptom burden concentrated within a single substance, therefore, early comprehensive screening and intervention strategies are needed.

PMID:
42435480
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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