Unravelling Polygenic Risk and Environmental Interactions in Adolescent Polysubstance Use: a U.S. Population-Based Observational Study.

BACKGROUND

Polysubstance use (PSU), defined as the use of multiple psychoactive substances, is associated with a heightened risk of subsequent health issues, including substance use disorders. However, the interplay between genetic susceptibility and environmental exposures in PSU initiation during adolescence remains understudied.

METHODS

We examined associations of polygenic scores (PGSs) for general addiction risk, environmental factors, and their joint interactions with PSU initiation among 11,868 adolescents (aged 11-15 years) from the Adolescent Brain and Cognitive Development study. PSU status was assessed through interviews and toxicology screenings.

RESULTS

Our sample included 7,898 adolescents (mean age 12.9 [0.6] years; 4,150 [53%] male). Of these, 541 (6.8%) had initiated single substance use (SSU), and 162 (2.1%) reported PSU). PGSs for general addiction risk were significantly associated with PSU (Odds Ratios [OR]=1.62, 95% CI=1.30-2.01) but not with SSU. Key environmental risk factors for PSU included prenatal substance use and peer victimization, whereas protective factors included planned pregnancy and positive family dynamics. Notably, gene-environment interaction analyses revealed that peer victimization (OR=2.4, 95% CI=1.4-4.2), prenatal substance use (OR=2.1, 95% CI=1.2-3.6), and substance availability (OR=2.3, 95% CI=1.3-3.9) substantially increased PSU risk among adolescents with high genetic susceptibility, while having minimal influence at low genetic risk levels (all p < 0.05 after multiple testing correction).

CONCLUSIONS

This study provides novel evidence linking polygenic risk to PSU in early adolescence and highlights PSU as a more severe manifestation of substance use liability driven by heightened genetic vulnerability and adverse environmental exposures.