Is age of onset and duration of stimulant therapy for ADHD associated with cocaine, methamphetamine, and prescription stimulant misuse?

BACKGROUND: To assess whether age of onset and duration of stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) are associated with cocaine, methamphetamine, and prescription stimulant misuse during adolescence. METHODS: Nationally representative samples of US 10th and 12th grade students (N = 150,395) from the Monitoring the Future study were surveyed via self-administered questionnaires from 16 annual surveys (2005-2020). RESULTS: An estimated 8.2% of youth received stimulant therapy for ADHD during their lifetime (n = 10,937). More than one in 10 of all youth reported past-year prescription stimulant misuse (10.4%)-past-year cocaine (4.4%) and methamphetamine (2.0%) use were less prevalent. Youth who initiated early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years) did not have significantly increased adjusted odds of cocaine or methamphetamine use relative to population controls (ie, non-ADHD and unmedicated ADHD youth). Youth who initiated late stimulant therapy for ADHD (≥10 years old) and for short duration (<1 year) had significantly higher odds of past-year cocaine or prescription stimulant misuse in adolescence than those initiating early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years). Youth who initiated late stimulant therapy for ADHD (≥10 years) for short duration (<1 year) had significantly higher odds of past-year cocaine, methamphetamine, and prescription stimulant misuse versus population controls during adolescence. No differences in past-year cocaine, methamphetamine, and prescription stimulant misuse were found between individuals who only used non-stimulant therapy for ADHD relative to youth who initiated early stimulant therapy (≤9 years old) and for long duration (≥6 years). CONCLUSIONS: An inverse relationship was found between years of stimulant therapy and illicit and prescription stimulant misuse. Adolescents with later initiation and/or shorter duration of stimulant treatment for ADHD should be monitored for potential illicit and prescription stimulant misuse.

Age 18-30 trajectories of binge drinking frequency and prevalence across the past 30 years for men and women: Delineating when and why historical trends reversed across age.

Historical analyses based on US data indicate that recent cohorts engage in lower binge drinking at age 18 relative to past cohorts, but by the mid- to late-20s the reverse is true: recent cohorts engage in higher binge drinking relative to past cohorts. We pinpoint when - both developmentally and historically - this reversal manifested, examine possible reasons for this reversal, and examine sex convergence in these developmental and historical patterns. As part of the US national Monitoring the Future Study, over 75,000 youths from the high school classes of 1976-2006 were surveyed biennially between ages 18 and 30. We found that the reversal primarily manifested between ages 18 and 24 for men and 18 and 22 for women. We also found that the reversal emerged gradually across the last three decades, suggesting it is the result of a broad and durable historical shift. Our findings indicated that historical variation in social roles and minimum legal drinking age collectively accounted for only a modest amount of the reversal, although marriage was the most influential among the factors examined here. Finally, we found evidence that sex convergence in binge drinking was developmentally limited and far more pronounced at the beginning of the transition to adulthood.

The Initiation and Developmental Course of Prescription Drug Misuse Among High School Athletes During the Transition Through Young Adulthood.

The objective of this study was to examine the extent to which involvement in high-contact, semicontact, or noncontact sports during the 12th grade is associated with the initiation and developmental course of prescription drug misuse (PDM) between ages 17/18 years and 27/28 years. Data were collected from a national multicohort panel sample of US 12th-graders (cohorts 2006-2017; n = 4,772) from the Monitoring the Future Study who were followed for a decade, through age 27/28 years. Approximately 31% of high school seniors indicated PDM at baseline (age 17/18 years). While past-year PDM remained relatively stable between ages 17/18 years and 27/28 years, participation in both noncontact (adjusted odds ratio = 1.40, 95% confidence interval: 1.02, 1.91) and contact (adjusted odds ratio = 1.57, 95% confidence interval: 1.08, 2.28) sports in the 12th grade increased the odds of initiating prescription stimulant misuse during the 10 years following high school as compared with respondents who did not participate in these types of sports in the 12th grade. To our knowledge, this is the first national study to have assessed how sports participation during high school is associated with the initiation and developmental course of PDM from adolescence to young adulthood. These findings reinforce the need for PDM screening during adolescence, as nearly 1 in 3 high school seniors engage in PDM. Increased prescription stimulant misuse following high school warrants ongoing monitoring during young adulthood, especially among athletes.

Trajectories of prescription opioid and heroin use in adulthood.

BACKGROUND AND OBJECTIVES: Due to a reduction in the availability of prescription opioids in the United States, the potential transition from prescription opioids to heroin is a public health concern. We assessed trajectories of both nonmedical prescription opioid (NMPO) and heroin use from adolescence (age 18) to adulthood (age 50) and how these trajectories were associated with substance use disorder (SUD) in adulthood (age 35-50). METHODS: A national sample of 26,569 individuals from eleven cohorts of US high school seniors (1976-1986) who were followed until age 50 (2008-2018). The analysis focuses on respondents who engaged in past-year NMPO and heroin use. Outcomes included the endorsement of two or more SUD symptoms. RESULTS: Among NMPO users, 7.5% had used heroin by the age of 50. The latent profile analyses assessing individuals who reported both NMPO and heroin use during the 32-year study period found four unique trajectory groups: (1) "age 18 concurrent use" (81.2%); (2) "mid-30s NMPO-to-heroin use transition" (10.7%); (3) age 19/20 NMPO-to-heroin use transition, followed by 40s heroin-to-NMPO use transition (4.3%); and (4) "mid-20s NMPO-to-heroin use transition" (3.7%). Respondents in the "mid-30s NMPO-to-heroin use transition" trajectory group had the highest odds of indicating two or more SUD symptoms between ages 35-50. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: This is the first study to assess NMPO and heroin use trajectories among a national probability-based sample followed from age 18 to 50. The findings suggest that prescription opioid misuse is a risk factor in the development of SUDs and has a long-term impact.

Negative evaluation of role transitions is associated with perceived stress and alcohol consequences: Examination of the Transitions Overload Model in young adulthood using two years of monthly data.

BACKGROUND: Young adulthood is characterized by transitions into and out of social roles in multiple domains. Consistent with self-medication models of alcohol use, the Transitions Overload Model (J Stud Alcohol Suppl, 14, 2002, 54) hypothesizes that one cause of increased alcohol use during young adulthood may be the stress of navigating simultaneous role transitions. This study examined the simultaneous occurrence of major developmental role transitions in the domains of education, employment, romantic relationships, and residential status and their associations with perceived stress, heavy episodic drinking (HED), and negative alcohol-related consequences. Further, we extended the Transitions Overload Model to explore whether the number of transitions rated as having a negative impact on one's life was related to perceived stress, HED, and alcohol-related consequences. METHODS: A community sample of young adult drinkers (N = 767, 57% women, ages 18 to 25 years) in the Pacific Northwest provided monthly data across 2 years. Multilevel models were used to assess the average (between-person) and month-to-month (within-person) associations of role transitions with perceived stress, HED, and negative alcohol-related consequences. RESULTS: Although having more role transitions was positively associated with HED frequency and alcohol-related consequences at both the between- and within-person (monthly) levels, it was not associated with increased stress. The number of transitions rated as having a negative impact on one's life, however, was positively associated with stress. Thus, rather than the total number of transitions, it is the number of negatively perceived major developmental role transitions that is associated with perceived stress and increased risk for negative alcohol-related consequences. CONCLUSIONS: Contrary to Transitions Overload Model assumptions, more transitions were not a significant predictor of more perceived stress; rather, the evaluation of the transition as negative was associated with stress and negative alcohol-related outcomes. This distinction may help elucidate the etiology of stress and subsequent alcohol consequences and identify individuals at-risk of these effects.

Boredom by Sensation-Seeking Interactions During Adolescence: Associations with Substance Use, Externalizing Behavior, and Internalizing Symptoms in a US National Sample.

During adolescence, sensation seeking is linked to several adverse outcomes including substance use, risk taking, and psychopathology. Recent empirical interest in the construct of boredom has revealed that some similar associations may exist for boredom during adolescence. Both boredom and sensation seeking peak during adolescence, and yet, research on boredom and its interaction with sensation seeking are limited. In a multi-cohort, US nationally representative sample of 8th and 10th grade students from the monitoring the future study, latent-moderated structural equation modeling was used to estimate the association of boredom, sensation seeking, and their interaction, to substance use, externalizing behavior, and depressive affect. Moderation by gender was also tested. Boredom and sensation seeking were both significantly associated with most dependent variables. Significant interaction effects were found wherein individuals high on both boredom and sensation seeking reported the highest levels of depressive affect and externalizing behavior. There were no significant interaction effects for substance use indices. Gender moderation was found for depressive affect. The results of this study demonstrate the generalizability of boredom associations and the significance of boredom by sensation-seeking interactions across multiple mental health domains during adolescence. Prevention efforts that attend to both boredom and sensation seeking may be particularly effective for promoting mental health and preventing externalizing behavior.

Transitions Catalyst Model: Testing within- and between-Person Associations between Social Relationships and Alcohol Use, Motives, and Consequences among Young Adults.

Background: The Transitions Catalyst Model suggests increased drinking during young adulthood is due to the notion that alcohol facilitates friendships and romantic/sexual relationships during a developmental period when these relationships are highly valued. However, little research has tested the utility of this model. We examined (1) whether young adults reported greater drinking and related consequences on months when friendships were more important to them or when they were dating casually, and (2) the extent to which social drinking motives explain these associations on a given month. Methods: Data were drawn from 752 young adults (ages 18-23 at screening) living in the Seattle, WA area (56.4% female). For 24 consecutive months, surveys assessed past month alcohol use and consequences, social drinking motives, friendship importance, and dating/relationship status. Bayesian multilevel models were conducted, adjusting for time-fixed and time-varying covariates. Results: Analyses included 11,591 monthly observations. Between-persons, greater average friendship importance was associated with greater drinking. On months when participants reported greater friendship importance than their own average, they reported greater drinking and alcohol consequences. Those who reported more months of casual dating reported greater drinking and consequences on average. Relative to casual dating months, participants reported less drinking during months they were single or in a relationship and fewer consequences during months in a relationship. Associations were partially accounted for by social motives. Discussion: Findings support the Transitions Catalyst Model. Effective strategies for reducing drinking and associated risks among young adults include brief interventions focused on how social drinking motives and relationships relate to drinking decisions.

Concussion, sensation-seeking and substance use among US adolescents.

BACKGROUND: No large-scale epidemiological survey of adolescents in the US has assessed the association between lifetime history of concussion, propensity toward sensation-seeking, and recent substance use. Methods: This study assesses the association between lifetime history of diagnosed concussions, sensation-seeking, and recent substance use (i.e., cigarette use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) using the 2016 and 2017 Monitoring the Future study of 25,408 8th, 10th, and 12th graders. Results: Lifetime diagnosis of concussion was associated with greater odds of past 30-day/2-week substance use. Adolescents who indicated multiple diagnosed concussions (versus none) had two times greater odds of all types of recent substance use, after adjusting for potential confounding factors. Adolescents indicating multiple diagnosed concussions also had higher adjusted odds of cigarette use, binge drinking, and marijuana use) when compared to adolescents who only indicated one diagnosed concussion. Accounting for adolescents' propensity toward sensation-seeking did not significantly change the association between substance use and multiple diagnosed concussions. Conclusions: This study provides needed epidemiological data regarding concussion and substance use among US adolescents. Exposure to a single diagnosed concussion is associated with a modest increase in the risk of substance use and this association increases with the accumulation of multiple diagnosed concussions. These associations hold when controlling for sensation-seeking. Substance use prevention efforts should be directed toward adolescents who have a history of multiple concussions.

Shifting Age of Peak Binge Drinking Prevalence: Historical Changes in Normative Trajectories Among Young Adults Aged 18 to 30.

BACKGROUND: This study examined the extent to which the developmental pattern of prevalence of binge drinking in the past 2 weeks from ages 18 through 30 has changed across 29 cohorts of U.S. young adults, and whether the changes differed by gender. METHODS: Analyses used national longitudinal data from 58,019 12th-grade students (from graduating high school classes 1976 to 2004) participating in the Monitoring the Future study followed through modal age 30 (with age 29/30 data collected from 1987 to 2016). Weighted time-varying effect modeling was used to model cohort group differences in age-related patterns of binge drinking. RESULTS: The age of peak binge drinking prevalence increased across cohorts (from age 20 in 1976 to 1985 to 22 in 1996 to 2004 for women, and from 21 in 1976 to 1985 to 23 in 1996 to 2004 for men). Historical change in the developmental pattern of binge drinking across all ages of young adulthood differed for men and women. Even after controlling for key covariates, women in the more recent cohort group reported significantly higher binge drinking prevalence than women in earlier cohorts from ages 21 through 30. Men in the more recent cohort group reported higher binge drinking prevalence at ages 25 to 26, but prevalence levels then converged to those seen in earlier cohort groups by age 30. CONCLUSIONS: An older age of peak binge drinking and a decreased rate of decline in the prevalence of binge drinking in later young adulthood among more recent cohorts have resulted in an extension of individual and societal risks associated with binge drinking, particularly for women, across young adulthood. High-risk alcohol use prevention efforts are needed throughout at least the third decade of life.

Tobacco and Alcohol Use Among Youth in Low and Middle Income Countries: A Multi-Country Analysis on the Influence of Structural and Micro-Level Factors.

BACKGROUND: The transition from adolescence to adulthood is a critical life phase as it is during this period that substance use and disorders typically emerge and escalate. Globally, few studies have examined the prevalence and correlates of alcohol and tobacco use among youth (ages 15-24). This study seeks to bridge this gap by assessing the influence of structural and micro-level factors on tobacco and alcohol use among youth in Low- and Middle-income countries (LMICs). METHODS: Data are drawn from the Multiple Indicator Cluster Surveys (MICS) conducted in 29 countries or regions in Eastern Europe, Latin America, Asia and Africa between 2010 and 2015. Analyses focus on lifetime prevalence and age of onset for tobacco and alcohol use. RESULTS: Descriptive analyses highlight regional variations in the prevalence and age of onset of tobacco and alcohol use: tobacco use is more concentrated among youth in Eastern Europe but alcohol use is generalized across the regions. Using multi-level analyses, we find statistically significant main effects for age, gender, educational attainment, rural residence, marital status and exposure to mass media on tobacco and alcohol use outcomes as well as interaction effects for age, gender and education on tobacco and alcohol use outcomes. Conclusions/importance: These findings highlight the need for structural interventions to control tobacco social marketing, and for gender considerations in tobacco and alcohol use prevention programs and policies.

Autonomy-related Parenting Processes and Adolescent Adjustment in Latinx Immigrant Families.

It is unclear how autonomy-related parenting processes are associated with Latinx adolescent adjustment. This study uses Latent Profile Analysis to identify typologies of parental monitoring and parent-adolescent conflict and examines their association with Latinx youth's school performance and depressive symptoms. The sample included 248 Latinx 9th and 10th graders (50% female) who completed surveys during fall (Time 1) and spring (Time 2) semesters of the school year. When compared to a high monitoring/low conflict parenting profile, a moderate monitoring/moderate conflict profile was associated with stronger declines in school performance; for boys, a high monitoring/moderately high conflict profile also was associated with greater increases in depressive symptoms. For Latinx immigrant families, researchers should consider monitoring and conflict as co-occurring processes.

Age-Specific Prevalence of Binge and High-Intensity Drinking Among U.S. Young Adults: Changes from 2005 to 2015.

BACKGROUND: This study examined changes during the past decade, from 2005 to 2015, in binge and high-intensity drinking in 7 separate age groups of U.S. 12th graders and young adults. METHODS: National longitudinal data (N = 6,711) from Monitoring the Future were used to examine trends in consuming 5+, 10+, and 15+ drinks on the same occasion in the past 2 weeks from ages 18 to 29/30 overall and by gender. Results were compared with trends in past 12-month and 30-day alcohol use for the same age groups. RESULTS: Between 2005 and 2015, binge (5+) and high-intensity drinking (10+, 15+) generally decreased for individuals in their early 20s, remained somewhat stable for individuals in their mid-20s, and increased for individuals at the end of young adulthood (age 29/30). The observed historical trends in binge and high-intensity drinking were similar to those for past 12-month and past 30-day alcohol use for those aged 18 to 20, but diverged for most other age groups in young adulthood. Trends were generally similar for men and women, except that the increase in prevalence began earlier in young adulthood for women than for men. CONCLUSIONS: Binge and high-intensity drinking among U.S. 12th graders and young adults are dynamic phenomena. Prevention and intervention efforts aimed at reducing the harms resulting from 5+, 10+, and 15+ drinking should acknowledge and focus on differences in trends in these behaviors by age and gender.

Adolescent adaptation before, during and in the aftermath of the Great Recession in the USA.

This study examines the impact of the "Great Recession" (from December 2007 to June 2009) on 8th and 10th graders in the USA, using annual nationally representative data from the Monitoring the Future study. Historical changes in youth adjustment (self-esteem, depressed mood, risk taking, aggression and property crime), school achievement (grade point average [GPA], time spent on homework and educational expectations) and structured and unstructured activities (volunteering, employment, sports and evenings out for fun) were examined between 1991 and 2014. Overall, there were only slight changes in mean levels of adjustment, achievement and most youth activities. However, the percentage of youth working during the school year did decline during the Great Recession. Several longer-term trends were also evident, though not directly tied to the Great Recession. These include an increase in GPA, a decrease in time spent on homework, rising educational expectations and more time spent volunteering. Future work should assess how the shift to unpaid work activities (e.g. volunteering and internships) among youth is impacting the transition from school to work in the contemporary economy, and whether the Great Recession had deleterious impacts for younger children or among youth whose parents lost work or had their homes foreclosed.

High-Intensity Drinking Among Young Adults in the United States: Prevalence, Frequency, and Developmental Change.

BACKGROUND: This study is the first to examine the developmental course of high-intensity drinking (i.e., consuming 10+ drinks in a row) across late adolescence and the transition to adulthood. METHODS: National longitudinal data (N = 3,718) from Monitoring the Future were used to examine trajectories of 10+ high-intensity drinking from age 18 through 25/26 overall and across sociodemographic subgroups; results were compared with similar analysis of 5+ binge drinking trajectories. RESULTS: Results document that 10+ drinkers consume not just a greater quantity of alcohol on a given drinking occasion, but also engage in 5+ drinking more frequently than drinkers who do not report having 10 or more drinks. Developmental patterns for 10+ and 5+ drinking were similar, with peak frequencies reported at age 21/22. Greater peaks in both 10+ and 5+ drinking were documented among men and among college attenders, compared with women and nonattenders, respectively. However, there was a steeper decline in 10+ drinking after age 21/22, indicating that risk for consumption of 10 or more drinks in a row is more clearly focused on the early 20s. Patterns of developmental change in both behaviors were driven largely by college students: No significant age-related change in 10+ drinking was observed among men and women who did not go to college, and no significant age-related change in 5+ drinking was observed among female nonattenders. CONCLUSIONS: Findings underscore the importance of recognizing high-intensity drinkers as a unique high-risk group, and that college attendance is associated with particularly strong peaks in the developmental course of high-intensity drinking.

High School Substance Use as a Predictor of College Attendance, Completion, and Dropout: A National Multi-cohort Longitudinal Study.

National data from Monitoring the Future were used to examine patterns and predictors of college attendance. Samples of American 12th-grade students from 1977-2003 were followed for seven years (modal ages 18-25; N=10,020). College attendance and graduation patterns varied considerably over historical time and based on family background. Substance use during high school predicted a greater likelihood of never attending (for cigarettes, illegal drugs), of graduating from a 2-year rather than a 4-year school (for cigarettes), and of dropping out versus graduating from a 4-year school (for cigarettes, marijuana, and other illegal drugs). High school binge drinking predicted lower college dropout, but only in models also controlling for cigarette, marijuana, and other illicit drug use. This study provides a needed overview of adolescent predictors of patterns of college attendance among American young adults over the past three decades.

PARTNERSHIP TRANSITIONS AND ANTISOCIAL BEHAVIOR IN YOUNG ADULTHOOD: A WITHIN-PERSON, MULTI-COHORT ANALYSIS.

OBJECTIVES: This study examines the effects of young adult transitions into marriage and cohabitation on criminal offending and substance use, and whether those effects changed since the 1970s as marriage rates declined and cohabitation rates rose dramatically. It also examines whether any beneficial effects of cohabitation depend on marriage intentions. METHODS: Using multi-cohort national panel data from Monitoring the Future (N = 15,875), the authors estimated fixed effects models relating within-person changes in marriage and cohabitation to changes in criminal offending and substance use. RESULTS: Marriage predicts lower levels of criminal offending and substance use, but the effects of cohabitation are limited to substance use outcomes and to engaged cohabiters. There are no cohort differences in the associations of marriage and cohabitation with criminal offending, and no consistent cohort differences in their associations with substance use. There is little evidence of differences in effects by gender or parenthood. CONCLUSIONS: Young adults are increasingly likely to enter romantic partnership statuses that do not appear as effective in reducing antisocial behavior. Although cohabitation itself does not reduce antisocial behavior, engagement might. Future research should examine the mechanisms behind these effects, and why non-marital partnerships reduce substance use and not crime.

Is Early Onset of Nonmedical Prescription Stimulant Use Associated With Cocaine Use During Adolescence? Results From a National Study.

BACKGROUND: To examine the associations between early onset of nonmedical prescription stimulant use (NPSU) and cocaine use. METHODS: Nationally representative samples of high school seniors were surveyed annually. Data were collected via self-administered questionnaires in nationally representative public and private schools in the United States (1976-2020) as part of the Monitoring the Future Study. The sample consisted of 45 cohorts of 12th grade students (N = 121 909). The main outcome was lifetime, past-year, and past-month cocaine use. RESULTS: An estimated one in every 10 (10.1%) individuals reported lifetime NPSU while 8.5% reported any cocaine use. The vast majority of youth (87.2%) initiated NPSU before cocaine among those who reported both substances. Cocaine use was most prevalent among youth who reported early onset of NPSU in 8th grade or earlier (51.7%) followed by those who reported later onset of NPSU in 12th grade (24.7%), and those who never initiated NPSU (3.7%). Binary logistic regression analysis indicated that early onset of NPSU had greater adjusted odds of cocaine use compared to those with later onset of NPSU or those who never reported NPSU. Moreover, the adjusted odds of cocaine use were higher for adolescents who initiated NPSU before or after medical use of prescription stimulants compared to those with no history of medical use or NPSU. Similar results were found for lifetime, past-year, and past-month cocaine use as a function of NPSU onset; this association was stronger among more recent cohorts. CONCLUSIONS: Early onset of NPSU appears to be a signal of increased risk of cocaine use among US adolescents. NPSU should be included in screening and early prevention strategies among secondary school students. Health professionals, school officials, and families are encouraged to monitor youth for NPSU based on the increased risk of later cocaine use and related consequences.

Attention-Deficit Hyperactivity Disorder Stimulant Therapy and Prescription Drug Misuse During Transition to Young Adulthood.

OBJECTIVE: Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants). METHODS: National longitudinal multicohort panels (baseline cohort years 2005-2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19-24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM. RESULTS: Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood. CONCLUSIONS: Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM.

Interaction matters: quantifying conduct problem × depressive symptoms interaction and its association with adolescent alcohol, cigarette, and marijuana use in a national sample.

Substance use is a major contributor to morbidity and mortality among American adolescents. Conduct problems and depressive symptoms have each been found to be associated with adolescent substance use. Although they are highly comorbid, the role of the interaction of conduct problems and depressive symptoms in substance use is not clear. In national samples of 8th-, 10th-, and 12th-grade students from the Monitoring the Future study, latent moderated structural equation modeling was used to estimate the association of conduct problems, depressive symptoms, and their interaction to the use of alcohol (including binge drinking), cigarettes, and marijuana. Moderation by age and sex was tested. The interaction of conduct problems with depressive symptoms was a strong predictor of substance use, particularly among younger adolescents. With few exceptions, adolescents with high levels of both conduct problems and depressive symptoms used substances most frequently. Conduct problems were a strong positive predictor of substance use, and depressive symptoms were a weak positive predictor. Whereas conduct problems are often thought to be a primary predictor of substance use, this study revealed that depressive symptoms potentiate the relation of conduct problems to substance use. Therefore, substance use prevention efforts should target both depressive symptoms and conduct problems.