Dual Impact of Family History of Substance Use Problems and Early Substance Use Onset in Developing a DSM-5 Substance Use Disorder Among U.S. Adults

Aims: Early substance use onset and family history of substance-related problems (FH+) have independently been linked to higher rates of substance use disorder (SUD) but have not been examined together to predict Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) SUD. This study examines the associations between early substance use onset and the development of later DSM-5 SUD among FH+ individuals versus those without a history (FH−). Design: National prevalence estimates were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, which used structured diagnostic interviews in U.S. adults ( N = 36,309 from 2012–2013). Methods: We examined four DSM-5 SUDs (alcohol, cannabis, prescription drugs, and any substance) as a function of family history and age of substance use onset using logistic regressions adjusting for sociodemographics, mental health, and substance use history. Results: A higher percentage of FH+ than FH− individuals who began substance use at or before 13 years of age developed a DSM-5 SUD (68.0% vs. 35.4%). Multivariate logistic regression analyses indicated that the adjusted odds of developing a DSM-5 SUD were reduced by 16% with each year substance use was delayed (adjusted odds ratio = 0.84, 95% confidence interval = 0.83–0.86). The adjusted odds of SUD were 2.69 times greater in those with the highest family history density of substance-related problems versus FH− individuals (95% confidence interval = 2.03–3.58). Conclusions: Early substance use onset was a significant predictor of DSM-5 SUD, especially for FH+ individuals. The findings highlight the importance of screening and preventive intervention efforts for addiction nursing practice to prevent or delay substance use onset, especially for FH+ U.S. youth.