Escalating Alcohol Use During Adolescence Is Associated With Non-medical Opioid Use in Young Adulthood

Opioid use disorder is rare among adolescents, but the incidence increases as teens transition to adulthood. This study used longitudinal data to examine alcohol consumption trajectories as antecedents of non-medical opioid use (NMOU; use of heroin or non-medical use of prescription opioids) among a sample of 580 predominantly African-American youth in Baltimore. Researchers assessed participants’ substance use annually from age 14 to 26.

  • Six trajectories of alcohol consumption were identified;* 2 trajectories (adolescent increasing and adolescent limited) were defined by substantial increases in alcohol consumption ages 14–18.
  • Unadjusted models found higher odds of NMOU only among individuals with the adolescent increasing and adolescent limited trajectories of alcohol consumption, compared with those with the abstaining trajectory of alcohol use.
  • Models adjusted for potential confounders found significant increases in the odds of NMOU among individuals with the adolescent increasing alcohol consumption trajectory (adjusted odds ratio [aOR], 3.3). Male gender was associated with an increased odds of NMOU (aOR, 1.7), while non-white race was associated with a decreased odds (aOR, 0.5).

* Alcohol use trajectories in this cohort were described thus: Young adult increasing (21% of participants; rapid increase in alcohol consumption age ≥18); adult increasing (19%; very little consumption age <21, frequency increasing ages 21–26); abstaining (19%; little to no consumption ages 14–26); experimenting (15%; infrequent consumption beginning in adolescence, little or no consumption by age 26); adolescent increasing (15%; consumption initiated in adolescence with rapid increase); and adolescent limited (10%; consumption initiated in adolescence, but declined at age 18).

Comments: The developing adolescent brain is particularly susceptible to substance use disorders. This article adds to the evidence that early unhealthy substance use serves as a marker of future risk, and suggests a true gateway. Prevention and intervention efforts targeting alcohol use that begins and escalates during adolescence may have an impact on future NMOU.

Sharon Levy, MD

Reference: Thrul J, Reboussin BA, Rabinowitz JA, et al. Alcohol trajectories and subsequent risk for opioid misuse in a cohort of urban adolescents. Subst Abus. 2021 [Epub ahead of print]. doi:10.1080/08897077.2021.1890675.

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