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Which adolescents develop persistent substance dependence in adulthood? Using population-representative longitudinal data to inform universal risk assessment

Published online by Cambridge University Press:  01 December 2015

M. H. Meier ,
W. Hall ,
A. Caspi ,
D. W. Belsky ,
M. Cerdá ,
H. L. Harrington ,
R. Houts ,
R. Poulton  and
T. E. Moffitt
M. H. Meier*
Affiliation:
Department of Psychology, Arizona State University, Tempe, AZ, USA
W. Hall
Affiliation:
University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia National Addiction Centre, King's College, London, UK
A. Caspi
Affiliation:
Department of Psychology and Neuroscience, Duke University, Durham, NC, USA Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
D. W. Belsky
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, NC, USA Social Science Research Institute, Duke University, Durham, NC, USA
M. Cerdá
Affiliation:
Department of Emergency Medicine, Violence Prevention Research Program, University of California Davis, Davis, CA, USA
H. L. Harrington
Affiliation:
Department of Psychology and Neuroscience, Duke University, Durham, NC, USA Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
R. Houts
Affiliation:
Department of Psychology and Neuroscience, Duke University, Durham, NC, USA Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
R. Poulton
Affiliation:
Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
T. E. Moffitt
Affiliation:
Department of Psychology and Neuroscience, Duke University, Durham, NC, USA Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: M. H. Meier, PhD., Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA. (Email: madeline.meier@asu.edu)
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Abstract

Background

To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood.

Method

Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972–1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years.

Results

A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80).

Conclusions

A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.

Keywords

Longitudinalrisk assessmentsubstance dependenceuniversal screen.
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 4 , March 2016 , pp. 877 - 889
Copyright
Copyright © Cambridge University Press 2015 

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