Does youthful experimentation with drugs and alcohol always fade with age? Not necessarily, a long-term study warns.
Researchers found that more than 60% of teens who report heavy use of alcohol, marijuana, and/or other drugs continue to have a drug problem as adults, often involving misuse of prescription medications.
The findings follow decades tracking more than 5,300 high school seniors, up until age 50.
"There has been some work suggesting most people age out of substance-related problems, but these studies have not adequately accounted for the severity of the substance-related problems," said study lead author Sean Esteban McCabe. He is director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan, in Ann Arbor.
"We found that most U.S. adolescents with severe substance use disorder symptoms persisted with multiple symptoms in middle adulthood," McCabe said.
The researchers began following a pool of U.S. high school seniors in 1976.
Their drug use habits were assessed at the outset. Then, participants were randomly surveyed every other year until age 30. From age 35 to 50, they were surveyed every five years.
About half the 5,317 participants were women; more than three-quarters were white.
At the outset, each teen was classified according to five levels of drug misuse. Those with two-to-three symptoms were categorized as having a "mild" abuse disorder. But those with the highest number of symptoms - six or more - were classified as having a "severe" drug issue.
In all, about 12% of 18-year-olds reported severe drug use issues. More than 40% indicated they had at least a mild drug problem.
Fast forward over the decades: six in 10 teens with a severe drug problem went on to exhibit at least mild drug misuse as adults, often involving different drugs, or a combination of several, the investigators found.
Even teens with mild drug problems appeared to face a high risk for continued issues as adults: 54% reported mild drug abuse concerns (or worse) as they got older.
McCabe's team also found that the more severe a teen's drug problem was, the more likely he or she would end up misusing prescription medications later on.
Looked at in reverse, the researchers observed that more than half of those who were (legitimately) prescribed opioids, sedatives or tranquilizers in adulthood had struggled with drug problems as kids.
McCabe said that alone raises "very serious concerns about the safety of prescribing controlled substances to these individuals," given that some young people clearly develop "unhealthy relationships with substances that persist over time."
He said that fact likely informs the record-setting over 100,000 drug overdose deaths in the United States last year.
And with that in mind, McCabe urged people to take the findings seriously. Telling teens they will inevitably "mature out of their substance use disorders … is like advising a jar of pickles that they can become cucumbers some day," he said.
Dr. Nora Volkow, director of the U.S. National Institute on Drug Abuse (NIDA), co-wrote a commentary that accompanied the study findings.
Volkow suggested that paying greater attention to youthful drug issues could help reduce the risk for lifelong problems.
"Screening for drug use early in an individual's life is an important part of evidence-based interventions to help identify substance use disorder risk, and possibly prevent these disorders and associated negative outcomes, such as drug overdoses in adulthood," she noted.
Volkow said health care systems, communities, schools and financial systems that support them must be ready to incorporate screening not only to identify drug use but also its severity.
NIDA funded McCabe's research, which was published online April 1 in JAMA Network Open.
The U.S. National Institute on Drug Abuse has more about teens and drug use.
SOURCES: Sean Esteban McCabe, PhD, professor, health behavior and biological sciences, and director, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor; Nora Volkow, MD, director, National Institute on Drug Abuse, Bethesda, Md.; JAMA Network Open, April 1, 2022, online