Abstract
The full text of this article is freely and openly accessible from the following repository: https://europepmc.org/articles/pmc4752874
Importance: Longitudinal studies have shown that youth exposed to particular risks are more likely to develop substance dependence, and these studies point to potential targets for prevention. They do not, however, directly address the pressing public health question of how accurately we can predict the development of persistent substance dependence in the general population.
Objective: To determine how accurately childhood and adolescent risk factors can predict persistent substance dependence. Design: A 38-year, prospective, longitudinal study of a representative birth cohort. Setting: The Dunedin Multidisciplinary Health and Development Study of New Zealand.
Participants: The study included 1,037 male and female participants.
Exposure: Prospectively assessed predictors included family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status.
Main Outcome Measures: Persistent substance dependence was defined as dependence on one or more of alcohol, tobacco, cannabis, or hard-drugs at three or more assessment ages: ages 21, 26, 32, and 38.
Results: An ROC curve analysis showed that a cumulative index of childhood and adolescent risk predicted persistent adult substance dependence with an AUC (area-under-the-curve) of 0.80 a large effect. Daily tobacco use in adolescence was the single best predictor of later persistent substance dependence, accurately identifying 68% of those who developed persistent substance dependence in adulthood. Nearly 1 in 2 adolescents who used tobacco on a daily basis developed severe substance dependence that persisted through early midlife.
Conclusions and Relevance: We can predict with considerable accuracy which individuals will develop persistent substance dependence in adulthood based on information obtained in childhood and adolescence. By ascertaining adolescent tobacco use, clinicians, parents, and teachers, can efficiently identify the majority of individuals who will struggle with persistent substance dependence in adulthood.