Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors · 2026
Familial risk factors required to predict earlier adolescent substance use in youth with externalizing disorders.
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Smoker Michael P, Mattey-Mora Paola P, Crum Kathleen I, Abu-Sultanah Mohannad, Murray Olivia K, Chimelis-Santiago José R, Finn Peter R, Aalsma Matthew C, Hulvershorn Leslie A
Аннотация
OBJECTIVE: Externalizing behaviors and family history of substance-use disorders (SUDs) are well-established childhood predictors of adolescent and adult substance use/SUDs. These two risk factors frequently co-occur and are often confounded in developmental research. This study aimed to disentangle these risk factors and determine to what extent familial-SUD history enhances risk for substance-use/SUD development in youth with externalizing disorders.
METHOD: SUD risk status of substance-naïve youth (n = 212), aged 11-12 years at baseline, was categorized as high-risk (HR; externalizing disorders and family history of SUDs), psychiatric comparison (PC; externalizing disorders only), or typically developing comparison (TDC). Youth completed a baseline assessment battery and were assessed longitudinally for substance use at 6-month intervals through 18 years of age. Group estimates (HR, PC, TDC) of hazard ratios for substance-use initiation, problematic use, and risky use were estimated using Cox regression models.
RESULTS: HR youth-initiated substance use earlier than both PC youth (adjusted hazard ratio; aHR = 2.31, CI = [1.39, 3.83]) and TDC youth (aHR = 2.68, CI = [1.38, 5.19]). HR youth also transitioned more rapidly than PC/TDC youth to problematic substance use (aHR's 2.16/2.32, CI's [1.19-3.91, 1.05-5.11]) and to risky substance use (aHR's 2.50/2.56, CI's 1.34, 4.59/1.15, 5.67). PC and TDC youth did not differ in substance-use trajectories.
CONCLUSIONS: Although there is considerable support for an externalizing behavioral phenotype in youth as a driver toward adolescent substance use, this predictive association was found to manifest only in the context of familial-SUD history. Familial SUD status may warrant particular consideration in the identification of and intervention with youth at risk for SUDs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
METHOD: SUD risk status of substance-naïve youth (n = 212), aged 11-12 years at baseline, was categorized as high-risk (HR; externalizing disorders and family history of SUDs), psychiatric comparison (PC; externalizing disorders only), or typically developing comparison (TDC). Youth completed a baseline assessment battery and were assessed longitudinally for substance use at 6-month intervals through 18 years of age. Group estimates (HR, PC, TDC) of hazard ratios for substance-use initiation, problematic use, and risky use were estimated using Cox regression models.
RESULTS: HR youth-initiated substance use earlier than both PC youth (adjusted hazard ratio; aHR = 2.31, CI = [1.39, 3.83]) and TDC youth (aHR = 2.68, CI = [1.38, 5.19]). HR youth also transitioned more rapidly than PC/TDC youth to problematic substance use (aHR's 2.16/2.32, CI's [1.19-3.91, 1.05-5.11]) and to risky substance use (aHR's 2.50/2.56, CI's 1.34, 4.59/1.15, 5.67). PC and TDC youth did not differ in substance-use trajectories.
CONCLUSIONS: Although there is considerable support for an externalizing behavioral phenotype in youth as a driver toward adolescent substance use, this predictive association was found to manifest only in the context of familial-SUD history. Familial SUD status may warrant particular consideration in the identification of and intervention with youth at risk for SUDs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).